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. 4 <br /> UST OPERATOR MONTHLYINSPECTION <br /> Facility Name:French Camo Cardlock v <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 Certificatio �er:821�8604 Expiration Date:8-29-15 <br /> Signature: Date: <br /> fir . .. 0 <br /> tem 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 /> L4Each Ldo previous month has been responded to appropriately. ❑ank-top containment sumps have not alarmed in the past month. ® ❑ ❑arm has occurred in the past month must be inspected unless a qualified service technician respond to,and properly addressed,the cause of thetion verifying a ro riate service to this re rt. If sum inspection is required,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 insDection of sums is only required in sums where an alrm has occurred in the past month for which there is no service record. <br /> Y N N/A 4110 <br /> N N/A <br /> Sump Location: ❑ ❑ ❑ Sump Location: ❑ ❑ <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 /> YWEI <br /> Y N N/A <br /> Tank 1—Contents: DFC k 6—Contents: ❑ ❑ ❑ <br /> Tank 2—Contents: ❑ k 7—Contents: ❑ ❑ ❑ <br /> Tank 3—Contents: k 8—Contents: <br /> Tank 4—Contents: ❑ k 9—Contents: ❑ ❑ <br /> Tank 5—Contents: ❑ k 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# El 0 <br /> s, <br /> Dispenser# <br /> -'Z Dispenser# ❑ <br /> Dispenser# t�, ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# sS El [IDispenser# El <br /> Dispenser# I,_ ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# 4a <br /> ❑ ❑ Dispenser# ❑ ❑ <br /> Dispenser# Dispenser# <br /> P.O.BOX 401,W SACRAMENTO,CA 95691 (800)477-7266 <br />