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Afforda-TeW <br />416 2nd Street <br />Galt, Ca 9502 <br />0.09-744-0112 Fax 209-744-0116 <br />Designated Operator <br />Monthly Inspection Checklist <br />100 1 Yosemite Ave JAN 16 2014 <br />ENVIRONMENTAL HEALTH <br />DEPARTMENT <br />0 David AWinmer El FeUx G. Rainim <br />#5263373 #5273934 <br />Manteca, CA 95337 <br />Lyle D. Iqlamo <br />#524911S <br />El Zone A. Nimmo <br />#5263322 <br />Date 11-1-13 <br />MOMTORMG PANEL / ALARM EUSTORY <br />Y N KA <br />Monitoring system, is powered on and in proper opaaft mode. <br />x <br />-Monitoft "em is not currently showing any alarms or warmhW. <br />x <br />Alarm history reporVlog for the previous mouth is available, and has been. reviewed by the I)mIgnoted UST <br />22 (Attach a copy!?f the alarm' g. <br />gp-Vaoform: - to this ifavailabla) <br />X <br />Each ala for the previous mouth has been responded to appropriately <br />x <br />Sensors located in tank -top cwtainment sumps have. not alarmed in the past month. <br />x <br />.hist all tank-io—p sumps where alarms occurred m thoo past month: <br />Note: %dVs where an alarm hies occurred 4n dwpmi mouth must be impectedwdess a qualriedX9"Ice technician resp ed anal proper <br />ad*=wd, Ow came of dw al= Anwh dwunwmdon verifying approprkne service to this report_ Ifnam p Inspection it required, record results <br />&Z bon 6 W <br />1111111111 <br />UST SYSTEM WSPECTION <br />ETTT7--A [- <br />14 <br />Y I N NA <br />Wank -top coWamela sumps are free of water, debris, and hazardous substance. Sensors are located property. <br />SON: Maw bawam ofsufto is Mdy ""4 as 'WhM an &kM IM Wcwftd w Au gg# month jbr which dim is no jwvwe record <br />Sump Location: 91 1 x I <br />Sump Location: 91 x <br />Sump Location DSL x <br />spiucontainment structures are free of water, 4debr)*S1 hazardous subomce- <br />Tank 1— regular I x <br />. . . ........ <br />Tank 2 91 <br />Tvmk 3 - DSL x <br />Under -dispenser corttainment flee of waterAebm, haWdoes substance. Sensors locafted. properly <br />Dispenser 1/2 <br />Dispenser 3/4 x <br />D 5/6 x <br />fAspexim 7/9 <br />