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Site ID : 1112 - 1 <br /> T1 <br /> � l l® rda - i eft e <br /> Designated Operator <br /> 416 2"d Street g p <br /> Galt, Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 _ <br /> roc DEPOT (RECEIVE ® 111atQ . A161IR <br /> JAN 14 2019 <br /> 1330 E YOSEMITE AVENUE <br /> ENVIRONMENTAL HEALTH <br /> MANTECA , CA 95336 PERMIT/SERVICES <br /> C1 Lane A. X111111110 ❑ David A. Winkler ❑ Belix G. Ramirez ® Edward Stearns <br /> #8883064 #8883059 #8883072 #8883080 <br /> Y = )? s N = no, NA = not alicable <br /> i UrE / A ; ItoivPONIWNii1R a y r' 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 report/log for the previous month is available, and has been reviewed by the Designated UST X <br /> Operator. (Attach a copy o the alarm histot y teeporillog report/logto this Orin i available) <br /> j 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 /> /Vote: Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to. and proper!,) <br /> addressed, the cause of the alarm. Attach documentation verifiling appropriate service to this report, If runup inspection is required rec6ord results <br /> in item 6, below. <br /> V N NA V N NA <br /> Tank-top containment sumps are free of water, debris , and hazardous substance. Sensors are located properly . <br /> _ Note: Visual ins ection o sums is only re aired in suer s where an alarm has occurred in the post month or irhich there is no service record. <br /> Sump Location : Sump Location : <br /> Sump Location : Sump Location : <br /> I _ <br /> Sump Location : a Sump Location : <br /> Sump Location : $n " Sump Location : { ° <br /> 3 <br /> tIV <br /> Sump Location : Sump Location : <br /> 1 44 <br /> Spill containment structures are free of water, debris, & hazardous substance. _ <br /> Tank 1 – Regular X Tank 5 – X <br /> I Tank 7 _ PlusX Tank 6 - � X <br /> IV <br /> i <br /> Tank 3 - Premium X Tank 7- X <br /> Tank 4 - Diesel X Tank 8 - X <br /> Under-dispenser containment free of water, debris , & hazardous substance. Sensors located properly . <br /> f Dispenser I /2 X Dispenser 19/20 X —� <br /> l- <br />