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&ROW <br /> UST OPERATOR MONTHLY INSPECTION.............. x I r-7D- <br /> Facility Name:French Camo Cardlock % 0 f <br /> Facility Address:10842 S.Harlan Rd 7 <br /> c <br /> City/State/Zip:French Camp <br /> Designated UST Operator:Steven richardson Phone:916-371.2570 <br /> HE 6 LTH <br /> ICC Certificati ber:8218604 Expiration Date:8-29-1 I rd <br /> Signature: D,afe: <br /> DEP MEIN 1 <br /> Item MONITORING PANELJALARM HISTO Y 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. 0 El El <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 verifying appro i <br /> riate service to this rcort. If sui ins ction is re wired,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 sums where an alrm has occurred in the past 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: ❑ ❑ 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: DFC ❑ 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: ❑ I ❑ ❑ I 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 a Dispenser# ❑ <br /> Dispenser# 0 11 Dispenser# ❑ ❑ ❑ <br /> Dispenser# C <br /> El Dispenser# ❑ ❑ <br /> D ❑ ❑ Dispenser# <br /> Dispenser# ❑ ❑ ❑ <br /> Dispenser# rj ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# L^_ ❑ Dispenser# <br /> Dispenser# Dispenser# <br /> W SACRAMENTO,CA 95691 (800)477-7266 <br />