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UST OPERATOR MONTHLY INSPECTION <br /> , <br /> Facility Name:French Camo Cardlock Al <br /> Facility Address:10842 S.Harlan Rd <br /> ,. <br /> City/State/Zip:French Camp <br /> Designated UST Operator.§Ievon richardson Phone:916-371`-2570 <br /> ICC Certification N er• 18604 Expiration Date.8-10-17 <br /> Signature: w <br /> ItemPS <br /> MONITORING PANEL/ALARM HISTORY Y N N/A <br /> Iing system is powered on and in proper operating mode. 10 10 <br /> 2ng system is not currently showing any alarms or warnings. <br /> 3 story report/log for the previous month is available,and has been reviewed by the Designated UST Operator.4 rm for the previous month has been responded to appropriately. ® ❑ ❑5 ocated in tank-top containment sumps have not alarmed in the past month.s where an alarm has occurred in the past month must be inspected unless a qualified service technician responed to,and properly addressed,the cause ofthe <br /> ch documentation verif in a ro appropriate service to this report. if sum inspection 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 inspection of sumps is only required in sumI <br /> occurred in the t month for which there is no service record. <br /> N N/A Y N N/A <br /> Sump Location: ❑ ❑ Sump Location: ❑ ❑ ❑ <br /> Sump Location: ❑ ❑ Sump Location: <br /> Sump Location: Sump Location: ❑ <br /> Sump Location: U I Ll I 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: D 0 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: 10-1 ❑ ❑ <br /> 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Y N N/A Y NNN/A <br /> Dispenser# f Dispenser# ❑ <br /> Dispenser# <br /> ❑ Dispenser# ❑Dispenser# Dispenser# ❑Dispenser# a l Dispenser# ❑ <br /> Dispenser# '"1 <" ❑ ❑ E] Dispenser# ❑ ❑ El <br /> nser# ❑ Dispenser# ❑ ❑ <br /> Dispenser# <br /> ❑ Dispenser# <br /> P.O.BOX 401,W SACRAMENTO,CA 95691 (800)477-7266 <br />