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Site ID: 1576-1 <br /> Affords-Te$t Designated Operator <br /> 416 2 Street p <br /> Galt, Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: J&L MARKET 2/151 ' % Dte: <br /> 8125 S ELDORADO STREET J U L 2 8 2017 <br /> ERFNC'.l-1 CAMP, C'A 95711 _ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> ®Zane A.Nimmo ❑David A.Winkler ❑Felix G.Ramirez ❑ Edward <br /> Stearns <br /> #5263322 #5263373 #5273934 <br /> #5250492 <br /> Y=yes N no.NA=not zopficable <br /> MONITORING PANEL I ALARM HISTORY Y N <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 o the alarm history report/logrepopfflog to thisform i 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:SEE BELOW <br /> !Vote:Sumps where an alarm has occurred in the past month must be inspected unless a qualifted service technician responded to,and properb <br /> addressed the cause of the alarm.Attach documentation verifving appropriate service to this report. Ifsump inspection is required,record rest <br /> in item 6,below. <br /> UST SYSTEM INSPECTION <br /> Y I N I NA I IY IN P <br /> Tank-top containment sumps are free of water, debris,and hazardous substance. Sensors are located properly. <br /> Note:Visual inspection o sum s is owy required in sun s where an alarm has occurred in the cmimonth for which there is no service record. <br /> Sump Location: 87 STP X ? Sump Location: <br /> Sump Location: 91 STP X Sump Location: <br /> Sump Location:DIESEL STP X Sump Location: <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- <br /> Tank 3-Premium X Tank 7- <br /> Tank 4-Diesel X Tank 8- <br /> Under-dispenser containment free of water,debris,&hazardous substance.Sensors located proMAy. <br /> Dispenser 12 X Dispenser 19/20 X <br /> t,,d d£ti:Z L L L 9Z Inf <br />