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UST OPERATOR MONTHLY INSPECTION ` <br /> gt <br /> me:French Camo Cardlock <br /> dress:10842 S.Harlan Rd <br /> ip:French Camp UST ter tor:Steven richardsonPhone:916-371-2570 <br /> cation umber:8218604Expiration Date:8-29-15 <br /> 'L- <br /> Date:r. <br /> Item MONITORING PA.NELIALARM HISTORY <br /> 1 MonitoY N N/A <br /> ring system is powered on and in proper operating mode. ❑ 112 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. ❑ El <br /> 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,theca <br /> use of the <br /> alarm. Attach documentation verif in a ro nate service to this re on. 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 ins ction of sums is only required in sums where an alrm 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 /> Sump Location: ❑ Sump Location: <br /> Sump Location: U1 0I ❑ Sump Location: ❑ <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> El <br /> Y N N/A Y N N/A <br /> Tank 1—Contents: DFC ❑ Tank 6—Contents: 1:1 10 ❑ <br /> Tank 2—Contents: ❑ El Tank 7—Contents: 13Tank 3—Contents: El Tank 8—Contents: El ❑ ❑ <br /> Tank 4—Contents: ❑ 13 Tank 9—Contents: El El ❑ <br /> Tank 5—Contents: El El ElTank 10—Contents: ❑ Li 118 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# Cr ❑ ❑ Dispenser# 11 11Dispenser# <br /> j ❑ Dispenser# ❑ ❑ <br /> Dispenser# <br /> ❑ Dispenser# ❑ <br /> 11Dispenser# ❑ ❑ <br /> t.� ❑ Dispenser# <br /> El E3Dispenser# r ❑ ❑ 13> t Dispenser# <br /> Dispenser# ❑ ❑ Dispenser# <br /> Dispenser# <br /> ❑ Dispenser# ❑ <br /> P.O.BOX 401,W SACRAMENTO,CA 95691 <br /> (800)477-7266 <br />