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DESIGNATED UNDERGROUND STORAGE OPERATOR <br />MONTHLY• <br />Facility Name New West # 1003 Date June 25, 2009 <br />Facility Address 6437 W. Banner Road <br />City, State, Zip Lodi, CA 95242 <br />Designated Operator Fast, Alex <br />ICC Certification # 5307848 -UC Expiration March 24, 2009 <br />Signature Phone (916) 869-0023 <br />UST SYSTEM INSPECTION <br />6 Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note: Visual inspection of sumps is only required in sumps where an alarm has occurred in the past month for which there is no service record. <br />Y N <br />Y <br />N <br />Sump Location: El ElSump Location: <br />1 <br />17 <br />El <br />Sump Location: ❑ ❑ Sump Location: <br />❑ <br />❑ <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />Y N NA <br />Y <br />N <br />NA <br />Gasoline - 87 0 ❑ ❑ Diesel <br />0 <br />❑ <br />❑ <br />Gasoline - 91 N ❑ ❑ <br />❑ <br />❑ <br />❑ <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N NA <br />Y <br />N <br />NA <br />Dispenser 1 / 2 N ❑ ❑ Dispenser 11 / 12 <br />0 <br />❑ <br />❑ <br />Dispenser 3 / 4 0 ❑ ❑ Dispenser 13 / 14 <br />0 <br />❑ <br />❑ <br />Dispenser 5 / 6 E ❑ ❑ Dispenser 15116 <br />N <br />❑ <br />❑ <br />Dispenser 7 / 8 N ❑ ❑ <br />❑ <br />❑ <br />❑ <br />Dispenser 9 /10 0 ❑ ❑ <br />❑ <br />❑ <br />❑ <br />©2007 WE - Page 1 Checklist P1 <br />