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Site 0:1275-1 <br /> Afforda-Te$t Designated Operator <br /> 4162"d Street g p <br /> Galt, Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: UNITED GAS Date: 6-26-14 <br /> 3440EMAIN RECEIVED <br /> STOCKTON CA <br /> JUL 4 120% <br /> ❑Zane A.Nimmo ® David A.Winkler ❑ Felix G. Ramirez ❑ Edward Stearns <br /> #5263322 #5263373 #5273934 #5250492 ^ ENVIRONMENTAL HEALTH <br /> DEPARTMENT <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/logreport/log 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. /f sump 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 /> Now 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: <br /> Sump Location:89 X Sump Location: <br /> Sump Location:91 X Sump Location: <br /> Sump Location: Sump Location: <br /> Sump Location: j Sump Location: <br /> Spill containment structures are free of water,debris,&hazardous substance. <br /> Tank I —Regular X Tank 5 - <br /> Tank 2—Plus X Tank 6- <br /> Tank 3 -Premium X Tank 7- <br /> Tank 4-Diesel Tank 8- <br /> Under-dispenser containment free of water,debris,&hazardous substance. Sensors located properly. <br /> Dispenser 1/2 X Dispenser 19/20 <br /> Dispenser 3/4 X Dispenser 21 <br /> Dispenser 5/6 X Dispenser 22/21 <br /> Dispenser 7/8 X Dispenser23/22 <br /> Dispenser 9/10 Dispenser 24/23 <br /> Dispenser 11/12 Dispenser 25/24 <br /> Dispenser 13/14 Dispenser 26/25 <br /> Dispenser 15/16 Dispenser 27/26 Satellite <br /> Dispenser 17/18 Dispenser 27 <br />