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m , <br /> JUL 2 $ 2017 <br /> ENVIRONMENTAL HEALTH Site ID_ 1576-1 <br /> Affords-Te$t o ' ' <br /> 416 2nd street , Designated operator <br /> Galt,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: J&L MARKET 1/16/17 Date: <br /> 8125 S. EL DORADO ST. <br /> FRENCH . (A 9 1)06 <br /> ®Zane A.Nimmo ❑David A.Winkler ❑ Felix G.Ramirez ❑ Edward Stearns <br /> #5263322 #5263373 #5273934 <br /> #5250492 l <br /> Y=Yes 1\=no,NA=not applikelble <br /> MONITORING PANEL I ALARM HISTORY Y N r <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 cga o the alarm history report/jogreportljog to this orm ' 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. X <br /> List all tank-top sumps where alarms occurred in the past month: <br /> Tote: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.If sump inspection is required record result. <br /> item 6.below. <br /> UST SYSTEM INSPECTION <br /> Y I N I 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 vast month or which there is no service record <br /> Sum Location:87 STP X Sump Location: <br /> Sump Location:91 STP X Sump Location: <br /> Sump Location:DIESEL STP X 5` " Sump Location: <br /> S ill containment structures are free of water,debris,&hazardous substance. <br /> Tank 1 -Regular X Tank 5- <br /> Tank 2—Plus X Tank 6- <br /> Tank 3-Premium X Tank 7- x <br /> Tank 4-Diesel X Tank 8- <br /> Under-dispenser <br /> -Under-di enser containment free of water,debris,&hazardous substance.Sensors located pr2MIy. <br /> Dispenser 112 XDispenser 19,120 x <br /> Dispenser 314 X Dispenser 21 x <br /> I'd d£ti:Z6 L L 9Z Inf <br />