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Site 0:1010-6 <br /> Afforda-Te$t <br /> 416 2nd Street Designated Operator <br /> Galt,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-7440116 <br /> Site: CJ CHEVRON <br /> Oate: 3-1a <br /> 11 " STREET <br /> TRACY, CA 9533717' <br /> C.`.. . <br /> ❑Zane A.Nimmo ®David A.Winkler ❑Felix G.Ramirez ❑ Edward Stearns <br /> #5263322 05263373 #5273934 #5250492 <br /> V- N-to.NA-not soolicabit <br /> MONITORING PANEL I ALARM HISTORY Y N NA <br /> Mooitoring 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 co the alarm history report/logreport1log to thisform '"available) <br /> Each alarm for the previous:mouth has been responded to appropriately X <br /> Sensors located in tarrk-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 thepast month must be inspected unless a qualified service technician responded to,and property <br /> addressed,the cause of the alarm.Attach documentation verifying appropriate service to this report.If sump inspection is required record results to <br /> imm 6,below. <br /> AST SYSTEM INSPECTION <br /> Y I N NA I I X I N NA. <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note:Visual i tion ofsumps is only m4uired in sumns where an alarm has occurred to the post mpnth or which there is no service record <br /> Sump Location:87 XSump Location: <br /> Sump Location:91 X Sump Location: <br /> Sump l ocation:DSl, X Sump Location: <br /> Spill containment structures are fw of water,debris &hazardous substance. <br /> Tank 1-Regular X Tank 5- X <br /> Tank 2—Plus X Tarek 6- X <br /> Tank 3-Premium X Tank 7- X <br /> Tanks 4-Diesel X Tank 8- X <br /> Under-dispenser containment free of water,debris,&hazardous substance. Sensors located ro er _ <br /> Dispenser 1/2 X Dispenser 19/20 X <br /> Dispenser 3/4 X Dispenser 21 X <br /> Dispenser 5/6 X Dispenser 22121 X <br /> Dispenser 7/8 X Dispenser23/22 X <br /> Dispenser 9110 X Dispenser 24/23 X <br /> Dispenser 11/12 1 X Dispenser 25124 X <br /> Dispenser 13/14 X Dispenser 26/25 X <br /> Dispenser 15116 X I Dispenser 27/26 Satellite X <br /> Dispenser 17/18 X I Dispenser 27 X <br />