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,ST OPERATOR MONTHLY 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,-3 570 <br /> ICC Certifica' mber:8218604 Ex datidn Date:8-29-15 S <br /> Signature <br /> � atm <br /> 1 ' <br /> Item MONITORING PANEI./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 respond to,and properly addressed,the cause of the <br /> alarm. Attach documentation verifyinn appropriate service to this re rt. if sum ins etion is re uired,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 property. <br /> Note: Visual inspection of sumps is only required in sums where an shot has occurred in the Past month for which there is no service record. <br /> Y I N N/A I Y 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 /> Y N N/A Y N I N/A <br /> Tank 1—Contents: DFC ❑ Tank 6—Contents: ❑ 01 ❑ <br /> Tank 2—Contents: Tank 7—Contents: ❑ El ❑ <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 I N/A <br /> Dispenser# 13&14 ❑ Dispenser# 11 ❑ <br /> El <br /> Dispenser# ❑ Dispenser# <br /> Dispenser# Dispenser# <br /> Dispenser# ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# ❑ Dispenser# ❑ <br /> Dispenser# ❑ ❑ Dispenser# ❑ <br /> ')X 401,W SACRAMENTO,CA 95691 (800)477-7266 <br />