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UST OPERATOR MONTHLY INSPECTION ! ' <br /> _ <br /> Facility Name:French Camo Cardlock <br /> Facility <br /> Address: S.Harlan Rd <br /> City/State/Zip:French Camp <br /> Designated UST Oper tor:Steven richardson Phone:916-371-2570 <br /> ICC Certificati ber:8218604 <br /> Expiration Date:8-29-1�_'_' <br /> Signature: <br /> i Date: <br /> ; _7Z z-r6 <br /> Item MONITORING PANEL/ALARM HISTORY <br /> Y N N/A <br /> 1FalarffLAuach <br /> ng system is powered on and in proper operating mode. ❑ ❑ <br /> 2ng system is not currently showing any alarms or warnings. ❑ <br /> 3istory report/log for the previous month is available,and has been reviewed by the Designated UST Operator. ❑ ❑ <br /> 4rm for the previous month has been responded to appropriately. ❑ ❑ <br /> 5 ocated in tank-top containment sumps have not alarmed in the past month. ® ❑ ❑ <br /> s where an alarm has occurred in the past month must be inspected unless a qualified service technician responed to,and property addressed,the cause of the <br /> ch documentation verifying a ro riate service to this re n.ifsump ins ction is r 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 ins coon of su is on, re uired in sum where an alma has occurred in the ast month for which there is no service record. <br /> Y N N/A Y N N/A <br /> Sump Location: ❑ ❑ Sump Location: ❑ ❑ <br /> Sump Location: ❑ ❑ ❑ Sump Location: ❑ <br /> SEl <br /> ump Location: ❑ ❑ ❑ Sump Location: <br /> El <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 ® ❑ Tank 6—Contents: <br /> Tank 2—Contents: ❑ Tank 7—Contents: ❑ ❑ ❑ <br /> Tank 3—Contents: ❑ ❑ Tank 8—Contents: ❑ ❑ ❑ <br /> Tank 4—Contents: ❑ ElTank 9—Contents: ❑ ❑ <br /> Tank 5—Contents: ❑I ❑ ❑ Tank 10—Contents: ❑ ❑ ❑ <br /> 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Y I N N/A Y N N/A <br /> Dispenser# i ❑ Dispenser# <br /> Dispenser# <br /> (j 2 ❑ ❑ Dispenser# <br /> Dispenser# ?, i L1 ❑ Dispenser# <br /> Dispenser# <br /> C,;lSr1 ❑ ❑ Dispenser# ❑ ❑ <br /> Dispenser# <br /> ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# ❑ ❑ ❑ Dispenser# C1 El <br /> Dispenser# ❑ ❑ Dispenser# ❑ ❑ <br /> '.O.BOX 401,W SACRAMENTO,CA 95691 (800)477-7266 <br />