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Site ID: <br /> Afforda-Test <br /> 416 2"d Street Designated Operator <br /> Gait,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: CD&R-TRACY TRUCK STOP , - Date: 11-7-16 <br /> 3940 N TRACY BLVD <br /> OCT ` 2017 <br /> TRACY, CA 95304 <br /> EWIRONNIC-�,';AL HEALTL <br /> ❑Zane A.Nimmo Ra •- - <br /> ®David A.Winkler `� <br /> Felix G.Ramirez -` l�'Edward Stearns <br /> #5263322 #5263373 #5273934 #5250492 <br /> Y= es N=no, A=notapplicable <br /> MONITORING PANEL/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 reportllog for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator. Attach a copy of the alarm history report/logreport1log to this form 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:Sumps 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 AST SYSTEM INSPECTION <br /> AUTO I Y I N I NA TRUCK I Y N NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note: Visual inspection o sums is only required in su s where an alarm has occurred in the past month for which there is no service record. <br /> Auto Sump Location:87 X = f Truck Sump Location:Diesel East X <br /> Auto Sump Location:91 X Truck Sump Location:Diesel West X <br /> Auto Sump Location: Diesel East X Truck Sump Location: <br /> Auto Sump Location:Diesel West X °' Truck Sump Location: X <br /> Spill containment structures are free of water,debris,&hazardous substance. <br /> Auto Tank I -Regular X Truck Tank 1 —Diesel East X <br /> Auto Tank 2—Premium X Truck Tank 2—Diesel West X <br /> Auto Tank 3—Diesel East X Truck Tank 3— X <br /> Auto Tank 4—Diesel West X Truck Tank 4— X <br /> Under-dispenser containment free of water,debris,&hazardous substance.Sensors located properly. <br /> Auto Dispenser 1/2 X Truck Dispenser 9a X <br /> Auto Dispenser 3/4 X Truck Dispenser 9/10a X <br /> Auto Dispenser 5/6 X Truck Dispenser 10/11a X <br /> Auto Dispenser 7/8 X Truck Dispenser 11/12a X <br /> Auto Dispenser 9/10 X Truck Dispenser 12/13a X <br /> Auto Dispenser 1 1/12 X Truck Dispenser 13/14a X <br /> Auto Dispenser 13/14 X Truck Dispenser 14/15a X <br />