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Site 0:1010-6 <br /> Afforda-Test Designated Operator <br /> 416 2 Streetg <br /> Galt, Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: Cr CHEVRON �� J�� `�� Date: 2-17-17 <br /> 11TH STREET ,j <br /> TRACY, CA 95337 -L+ <br /> -:7) <br /> ❑Zane A.Nimmo ❑David A.Winkler ❑Felix G.Ramirez ❑ Edward Stearns <br /> #5263322 #5263373 #5273934 #5250492 <br /> X= N no.NA=not a cable <br /> MON 'ORING PANEL/ALARM HISTORY x N N.A, <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 /> Alarcon:history report/log for the previous mouth is available,and has been reviewed by the Designated LUST X <br /> erator_ Attach a copy ofthe alarm his re ort/lo to this orm ' available. <br /> Each alarm for the previous wouth 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 m—curred in the past month must 6e inspected unless a qualified service technician responded to,and properly <br /> addressed,the cause of the alarm.Attach documentation vertfytrW appropriate service to this reporttfsump inspection is required record results in <br /> AIM 6 below. <br /> AST SYSTEM[INSPECTION <br /> Y I N I NA I Y I N NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note: Visual Inapection of sums is only requ ed rn sumps where an alarm has occurred in the payt month or which there is no service record <br /> Sump Location*87 X Sump Location: <br /> Sump Location.91 X Sump Location: <br /> Sump Location:DSL X Sump Location: <br /> Spill oontainment structures are free of water,debris,&hazardous substance. <br /> Tanis 1—Regular X Tank 5 - X <br /> Tank 2--Plus X Tank 6- X_ <br /> Tank 3-Premium X Tank 7- X <br /> Tank 4-Diesel X Tank 8- X <br /> Under-di eraser 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 Dispenset23/22 X <br /> Dispenser 9/10 X Dispenser 24/23 X <br /> Dispenser 11/12 X Dispenser 25/24 X . <br /> Dispenser 13/14 X Dispenser 26/25 X <br /> Dispenser 15/16 X Dispenser 27126 Satellite X <br /> Dispenser 17/18 X IDispenser 27 X <br />