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Site: 1450-1 <br /> Afforda-Te$t na <br /> Desi ted Operator <br /> 4162nd Street g` P <br /> Galt, Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: FOOD MART GASOLINE Date: 08-30-18 <br /> 2185 EAST FREMONT STREET <br /> STOCKTON, CA 95205 <br /> ❑Zane A.Nimmo ❑ David A.Winkler ®Felix G.Ramirez ❑ Edward Stearns <br /> #8883064 #8883059 #8883072 #8883080 <br /> r <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/logreportliog to this form 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.1f 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 /> Note:Visual inspection o sum s is only required in sum s where an alann has occurred in the past month for which there is no service record. <br /> Sump Location:87 X Sump Location: X <br /> Sump Location:91 X Sump Location: X <br /> Sump Location:DIE X Sump Location: X <br /> Sump Location: X Sump Location: X <br /> Sump Location: X I 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 />