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;s <br /> R <br /> r " <br /> UST OPERATOR T L INSPECTION <br /> Facility Name:French Camo Cardlock <br /> Facility Address:10842 S.Harlan Rd <br /> City/State/Zip:French Camp <br /> Designated UST Operator:Steven richardson Phone:916-371-2570 <br /> ICC Certification r:8218604 Expiration Date:8-29-15 rJ'M1 <br /> Signature: Date: w. <br /> Item MONITORING PANEL/ALARM HISTORY Y N N/A <br /> 1 Monitoring system is powered on and in proper operating mode. ® ❑ ❑ <br /> 2 Monitoring system is not currently showing any alarms or warnings. ® ❑ ❑ <br /> 3 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 responed to,and properly addressed,the cause of the <br /> alarm. Attach documentation verif in a ro riate service to this report. if sump inspection is re uued,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 inspection of sums is only required in sumps where an shot has occurred in the past month for which there is no service record. <br /> Y I N I N/A Y I N N/A <br /> Sump Location: ❑ ❑ ❑ Sump Location: ❑ 13 ❑ <br /> Sump Location: ❑ ❑ Sump Location: ❑ <br /> Sump Location: ❑ ❑ ❑ 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 I N N/A <br /> Tank 1—Contents: C� ® ❑ ❑ Tank 6—Contents: ❑ ❑ ❑ <br /> Tank 2—Contents: ❑ ❑ ❑ Tank 7—Contents: ❑ ❑ ❑ <br /> Tank 3—Contents: ❑ Tank 8—Contents: ❑ ❑ <br /> Tank 4—Contents: ❑ ❑ ❑ Tank 9—Contents: ❑ ❑ <br /> Tank 5—Contents: ❑ ❑ ❑ Tank 10—Contents: ❑ ❑ ❑ <br /> 8 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# ❑ Dispenser# ❑ 13 0 <br /> Dispenser# Zct ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# ❑ ❑ Dispenser# ❑ <br /> Dispenser# ❑ ❑ Dispenser# El El El... 1 . <br /> Dispenser# Cq G> ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# ❑ ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> P.O.BOX 401,W SACRAMENTO,CA 95691 (800)477-7266 <br />