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Site ID: 1010-6 <br /> Afforda-Tit Designated Operator <br /> 416 20d Street p <br /> Gait, Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: CD&R—CJ'S CHEVRON Date: 1-24-17 <br /> 7501 W 11"'STREET <br /> TRACY, CA 95304 <br /> ❑ Zane A.Nimmo ®David A.Winkler ❑ Felix G.Ramirez ❑ Edward Stearns <br /> #5263322 #5263373 45273934 #5250492 <br /> Y=yes N—no,NA=oot sulplicame <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 report/log for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator, Attach d copy o the alarm history re ortliog to this orm ' 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 qua! ed service technician responded to,andproperly <br /> addressed the cause of the alarm.Attach documentation verifying appropriate service to this report.If sump inspection is required,record results <br /> in item 6,below. <br /> AST SYSTEM IINSPEC77ON <br /> Y j N j NA I IY N NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note: Visual inVection ofmmTs a O required in=mps where an akin has ocewred in the past monthfor 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 Sunup Location: <br /> Spill containment structures are free of water,debris,&hazardous substance. <br /> Tank l—Regular x Tank 5- x <br /> Tank 2—Plus I X Tank 6- x <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 /> 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 Dispenser23/22 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 27/26 Satellite X <br /> Dispenser 17/18 X Dispenser 27 X <br />