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�� ®�1��– � � Desiundated �peaaator — <br /> 416 2nd Street Galt, Ca. 95632 Monthly Inspection Checklist <br /> 209 744-0112 - 800 524-9087 - Fax 209 744-0116 <br /> Site: " `/ - f BSf Date: 5;? tJ <br /> Designated Opeoto David . Winkler ICC # 5263373-UC Expiration: 3/3/08 <br /> Signature Yryes Ngo NA-not applicable <br /> MONITORING PANEL Z ALARM HISTORY Y N A <br /> Monitoring System is powered on and in proper operating mode. <br /> Monitoring system is not currently showing any alarms or warnings. <br /> Alarm history report for the previous month is available and has been reviewed by D.O. <br /> (Attach alarm history,if available) <br /> Each alarm for the previous month has been responded to appropriately, <br /> Sensors located in tank-top containment sumps have not alarmed in the past month. <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 he inspected unless a gualifted service technician responded <br /> to,and properly addressed, the cause of the alarm. Attach documentation verifying appropriate service to this report. <br /> If sump inspection is required,meord results in item#6 below. <br /> UST SYSTEM INSPECTION <br /> 1YN' YNN <br /> Tank-top containment sumps are free of water,debris, and hazardous substance. Sensors located properly. <br /> --Note: Visual inspection of sumps only required in sumps where an alarm has occurred in the past month for which there is no service record. <br /> -.-Sump location: Sum location: <br /> �:&inp location: Sump location: <br /> ""`Sump location: I I Sump location: <br /> Spill containment structures are free of water, debris, &hazardous substance. <br /> Tank I -Regular I JXI I Tank 4-Diesel x <br /> .Tank 2-Plus Tank 5 - x <br /> tank 3-Premium Tank 6- <br /> Under-dispenser containment free of water, debris &hazardous substance. Sensors located ro erl . <br /> -Dispenser 1/2 Dispenser 19/20 <br /> Dispenser 3/4 Dispeaser 21 X <br /> Dispenser 5/6 Dispenser 22/21 Satellite <br /> Dispenser 7/8 Dispenser 23/22 Satellite <br /> " <br /> Dispenser 9/10 'Dispenser 24/23 Satellite <br /> -Dispenser 11/12 IIispenser 25/24 Satellite <br /> Dispenser 13/14 X Tis enser 26/25 Satellite <br /> 53tispenseI 15/16 /( Dispenser 27/26 Satellite <br /> Dispenser 17/18 Dispenser 27 Satellite <br /> Facility Employee Training <br /> All facility employees have received the required on-the-job training within the past year. x <br /> All facility employees hired within the past 30 days have received the required on the job training. �" <br />