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Site ID:1010-6 <br /> Affords-Te$t <br /> 41.6 211d Street � p Designated Operator <br /> Galt,Ca 95632 Monthly Inspection Checldist <br /> 209-744-0112 Fax 209-7440116 <br /> Site: CJ CHEVRON` t, Date: 4-17-17 <br /> 11TH STREET .. <br /> TRACY, CA 95337 <br /> ® Zane A.Nimmo ❑David A.Winkler ❑Felix G.Ramirez ❑ Edward Stearns <br /> #5263322 #5263373 #5273934 #5250492 <br /> Y a yes N—no NA—not applicable <br /> MONITORING PANEL/ALARM WSTORY X 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 report/log for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator. Attach a copy ofthe alarm hisfory rgportllog to thisform 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 /> AST SYSTEM INSPEC'T'ION <br /> Y N Nt1I X I N NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly_ <br /> Note:I ewal t ectlon ofsumps iso re in sumps where an alarm has occurred in the Pail month or which there Is no service record <br /> Sump Location:87 XSump location: <br /> Sump Location:91 X Sump Location: <br /> Sump Location:DSL X Sump Location: <br /> Spill containment structures are free of water,debris &hazardous substance. <br /> Tank 1—Regular X Tank 5- X <br /> Tank 2—flus X Tank 6- X <br /> Tank 3-Premium X Tank 7- X <br /> Tank 4-Diesel X Taak 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 DispensW23/22 x <br /> Dispenser 9/10 X Dispenser 24/23 X <br /> Dispenser 11/12 XDispenser 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 Dispenser 27 X <br />