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y <br /> 1019-1 <br /> Afforda-Telt � <br /> 4162"d Street Designated nated Operator <br /> Gait, Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: DELTA ARCO <br /> RECEIVEte: 6-6-2011 <br /> 440 W CHARTER WAY AUG 29 2011 <br /> ENVIRONMENTAL HEALTH <br /> STOCKTON CA PERMIT/SERVICES <br /> ❑ Lyle D.Nimmo ❑Zane A.Nimmo ®David A. Winkler ❑ Felix G.Ramirez <br /> #5249115 #5263322 #5263373 #5273934 <br /> Signature: W <br /> Y=vcs N=no.NA=not an livable <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:SEE BACK <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.If 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.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 OCT X Sump Location: <br /> Sump Location:91 OCTX Sump Location: <br /> Sump Location: Sump Location: <br /> Spill containment structures are free of water,debris,&hazardous substance. <br /> Tank 1 -Regular X I Tank 4-Diesel X <br /> Tank 2—Plus X Tank 5: X <br /> Tank 3-Premium X Tank 6- X <br /> Under-dis enser containment free of water,debris,&hazardous substance.Sensors located properly. <br /> Dispenser 1/2 X Dispenser 19/20 X <br /> Dispenser 3/4 X Dispenser 21 X <br /> Dispenser 5/6 X Dispenser 22/21 X <br /> Dispenser 7/8 X Dispenser 23/22 X <br /> Dispenser 9/10 X Dispenser 24/23 X <br /> Dispenser 11/12 X Dispenser 25/24 X <br /> Dispenser 13/14 X Dispenser 26/25 X <br /> Dispenser 15/16 X Dispenser 27/26 Satellite X <br /> Dispenser 17/18 X Dispenser 27 X <br />