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• i <br /> Site ID: 1132-1 <br /> Afforda-Te$t <br /> 416 2nd Street Designated Operator <br /> Galt,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> .,w F � +sem°. <br /> (a <br /> Site: GRUPE COMMERCIAL , -- ` �1 te: 10-21-16 <br /> 5000 SOUTH LINDBERGH STREET 0 Q <br /> STOCKTON, CA 95206 <br /> ❑Zane A.Nimmo ❑David A.Winkler ®Felix G.Ra��' ff and Stearns <br /> #5263322 #5263373 #5273934 #5250492 <br /> �r <br /> Y=yes N=no,NA=not applicable <br /> MONITORING PANEL I ALARM HISTORY Y N NA <br /> Monitoring system is powered on and in proper operating mode. X <br /> Monitoring system is not currently showing any alarms or warnings. X <br /> Alarm history repordlog for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator. Attach a copy of the alarm histoiy report/logreport1log to this ornz if available. <br /> Each alarm for the previous month has been responded to appropriately X <br /> Sensors located in tank-top containment sumps have not alarmed in the past month. X <br /> List all tank-top sumps where alarms occurred in the past month: <br /> Note:Sutnps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to,and properly <br /> addressed,the cause of the alarm.Attach documentation verifying appropriate service to this report.If sump inspection is required,record results in <br /> item 6,below. <br /> UST SYSTEM INSPECTION <br /> Y I N I NA Y I N I NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note:Visual inspection o sunt s is only required in sura s where an alann has occurred in the past month or which there is no service record. <br /> Sump Location:JET A X I Sump Location: X <br /> Sump Location: X Sump Location: X <br /> Sump Location: X Sump Location: X <br /> Spill containment structures are free of water,debris,&hazardous substance. <br /> Tank 1-Regular X Tank 5 JET A X <br /> Tank 2—Plus X Tank 6- X <br /> Tank 3-Premium X Tank 7- X <br /> Tank 4-Diesel X I Tank 8- X <br /> Under-dispenser containment free of water,debris,&hazardous substance.Sensors located properly. <br /> Dispenser 1/2 X Dispenser 19/20 X <br /> Dispenser 3/4 X Dispenser 21 X <br /> Dispenser 5/6 X Dispenser 22/21 X <br /> Dispenser 7/8 X Dispenser 23/22 X <br /> Dispenser 9/10 X Dispenser 24/23 X <br /> Dispenser 11/12 X Dispenser 25/24 X <br /> Dispenser 13/14 X Dispenser 26/25 X <br /> Dispenser 15/16 X Dispenser 27/26 Satellite X <br /> Dispenser 17/18 X I Dispenser 27 X <br />