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A .1 <br /> O (p <br /> o 0 <br /> c i AT UNDERGROUND STORAGE"TANK SYSTT�N a rptYC � <br /> 6 (D " Mtt�6 D UST <br /> OPERATOR MONTHLY INSMSC _ C7 <br /> Tl e4g: 78 BiBnctU ChaO NT] oo Date 12/212 <br /> v N 1g Mere, <br /> 0 �t�USTlane City: Stockton <br /> Ode Comtel!C-+"r hi ConducUna Inspection: Dale Carea9a <br /> � R+ncation No.; gapiration Date: 10/4!2016 <br /> N 8250093-UC Phone: (530)749-9892 t* tki°t` 0- <br /> (D <br /> (D Ya No N/A <br /> Ortor� a—I1111111 tem werea^IT dRinNro ro ratn�t"ode7tISTORY X ^'• <br /> F (D ''r History R m oot careen[! showin an leak alarms- by the X <br /> (1ST epot'r/I it been reviewed <br /> 08 for Ne ctlon orm• X �„ <br /> � •� �—D rator� previous month available,and has <br /> IAtra <br /> CD seer[for the h a co oIlhe nlnnn hismrr re arl//o to this ns f.^ <br /> revrous month - <br /> (D � Ween res ondcd tna ro riatel <br /> slor <br /> uontairtrneryt aUm UST SYSTEM INSPEf-TION Ceq Nwe:1Jda•a,mver to hem J++'os rd'r+. an I <br /> ""hero e t s t s free of water,de ous substan nnr rcspoark' /1 <br /> "rhe mi has a�Yy Z to the beta•and hazard ted w1 fed srrvree rechnicion hae l J <br /> (n r rhe o%,ac i"amnrh^"er&auprc if, <br /> he orrached to this spore No <br /> OGannenranon ser mservlc+e Yes <br /> T. tn:PMIUM Yes No X <br /> � 'n• L11 III .. X Stun Location:DIESEL X <br /> tnntent s X Sum Location: G <br /> onta' nvctunes free of water,debris,and hazardous substance? Ya No NIA O <br /> (o 6 EA4-- Ya No N/A <br /> m --% [LEADED X Tank 4ID- <br /> o 3 :SEL X Tank 5 t - <br /> o uer contaimnent areas flee of water,debris,and h la7ardous substance? <br /> (a Yes No NIA (9 <br /> Yes No N/A X .� <br /> X Dis nser-9/10 X <br /> X Dis nser- 11/12 X <br /> X Dis nser- 13/14 X m <br /> X Dis nser- IS/l6 <br /> TPErlY located within underrvdis nsercontainrnent. YeS No N/A <br /> Yes No N/A <br /> X Dis nser-9/10 X <br /> X Dispenser- 11/12 X ' "S <br /> o X Dispenser- 13/14 X <br /> o X Dispenser- 15/16 X <br /> PAPERWORK INSPECTION Yes No N/A Date Done � <br /> vification was completed within the past 12 months? X 1111812014 <br /> ° ere tested/certified within the past 12 months" X 1111812014 <br /> Z mnt structure) testing completed within the past 12 months? X 11118!2014 D <br /> )mpleted within the required time frame? X VPH <br /> CT m tests completed within the required time frame? H <br /> X VP <br /> �, completed within the required time frame? ��i X N <br /> Nce was completed within uired time frame? (List test/maintenance items below. 1 <br /> li /Vapor X 101812014 <br />