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i <br /> UST OPERATOR OT LY INSPECTION ` <br /> r <br /> me:French Camo Cardlock <br /> dress:10842 S.Harlan Rd <br /> Zip:French Camp <br /> UST OXraor:Steven richardson Phone:916-371-2570 <br /> cati,A I inber:8218604 <br /> Expiration Date:8-10-17 <br /> �' <br /> Item MONITORING PANEL/ALARM HISTORY <br /> Y N N/A <br /> 1 Monitoring system is powered on and in proper operating mode. 11 ❑ <br /> 2 Monitoring system is not currently showing any alarms or warnings. El3 Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST Operator. ® ❑ ❑ <br /> 4 Each alarm for the previous month has been responded to appropriately. ® ❑ ❑ <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the past month. ® ❑ ❑ <br /> Note: Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician respond to,and properly addressed,the cause of the <br /> alarm. Attach documentation verif in a ro riale service to this re rt. If sum ins •coon is re aired,record results in item 6,below. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Note: Visual ins22ction of sums is only required in sums where an slim has occurred in the ast month for which there is no service record. <br /> Y N N/A WE030 <br /> Sump Location: ❑ ❑ ❑ Sump Location: <br /> Sump Location: ❑ Sump Location: <br /> Sump Location: 0 13 <br /> ❑ ❑ Sump Location: <br /> Sump Location: ❑ ❑ ❑ Sump Location: <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y N N/A Y N N/A <br /> Tank 1—Contents: DFC El ElTank 6—Contents: ❑ ❑ <br /> Tank 2—Contents: 11 Tank 7—Contents: ❑ ❑ ❑ <br /> Tank 3—Contents: ❑ 11 Tank 8—Contents: EE] E] ❑ <br /> Tank 4—Contents: ❑ ❑ El Tank 9—Contents: 1111 11—:1 11Tank 5—Contents: ❑ ❑ 11Tank 10—Contents: 11 ❑ El8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Y N N/A Y N N/A <br /> Dispenser# f ❑ ❑ Dispenser# 11 El <br /> # <br /> 1L1— . Dispenser# El El ❑ <br /> Dispenser# —1 c� � ❑ ❑ Dispenser# El 11Dispenser# <br /> 4'1 � ��`, ❑ ❑ Dispenser# 11 ❑ ❑ <br /> Dispenser# <br /> ❑ ❑ Dispenser# El 11 ElDispenser# ❑ ElDispenser# El <br /> # ❑ ❑ ❑ Dispenser# ❑ <br /> P.O.BOX 401,W SACRAMENTO,CA 95691 <br /> (800)477-7266 <br />