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Site ID: 1569-1 <br /> Afforda-Te$t Designated Operator <br /> 416 2nd Street g p <br /> Galt, Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> p. ;�. <br /> Site: QUICKI KLEEN CAR WASH Date: 1/18/18 <br /> 707 E YOSEMITE AVENUE J'Jw J' 4 ?016 <br /> MANTECA, CA 95336TH HEALTH <br /> DEPARTMENT <br /> ❑Zane A.Nimmo David A. Winkler ❑ Felix G.Ramirez ® Edward Stearns <br /> #8211269 45263373 #5273934 #8184188 <br /> �)j 4A�- <br /> Y= es N=no,NA=not applicable <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 a copy of the alarm history report/logreport1log 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.Ifsump inspection is required, record results <br /> in item 6, below. <br /> UST SYSTEM INSPECTION <br /> Y I N I NA I 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 inspection of sumps is only required in sum s where an alarm has occurred in the past month or which there is no service record. <br /> Sump Location: 87 X Sump Location: X <br /> Sump Location:DIE X Sump Location: X <br /> Sump Location:91 X Sump Location: X <br /> Sump Location: X Sump Location: X <br /> Sump Location: X Sump Location: X <br /> Spill containment structures are free of water,debris,&hazardous substance. <br /> Tank 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-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 Dispenser 23/22 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 I Dispenser 27 X <br />