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UST OPERATOR MONTHLY INSPECTION <br /> ;n <br /> Facility Name: <br /> R <br /> A <br /> MOS OIL-_FREC <br /> H C <br /> AMP <br /> Facility Address:10842 S HARLAN RD <br /> City/State/Zip:FRENCH CAMP/CA <br /> Designated <br /> UST Operator:* ve ichards)n <br /> ttH <br /> Phone:916-825-7412 <br /> ALTH <br /> ICC Certification Nu 604 <br /> OF Expiration Date:8-29- <br /> Signature: Date: //--2 G- 13 <br /> Item MONITORING PANEL/ALARM HISTORY Y N N//AA <br /> 1 Monitoring system is powered on and in proper operating mode. 0 El <br /> 2 Monitoring system is not currently showing any alarms or warnings. 0 11 <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST Operator. 1:1 Ell <br /> 4 Each alarm for the previous month has been responded to appropriately. <br /> Z 13 El <br /> Sensors located in tank-top containment sumps have not alarmed in the past month. <br /> Sumps where an alarm has occurred in the past month must he inspected unless a qualified service technician respond to,and property addressed,the cause of the <br /> alarm Attach documentation verif ini ap2roeri te service to this re ort. If sum inspection 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 sumps is only required in sumps where an alrm has occurred in the astmonth t. which there <br /> Y N N/A service record. Y N N/A <br /> Sump Location: El 11 11 Sump Location: El El El <br /> Sump Location: 0 El 0 Sump Location: El El El <br /> Sump Location: –a El El Sump Location: 11 0 11 <br /> SumpLocation: El 11 F1 Sump Location: El El E3 <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: ❑ F-1 El <br /> Tank 2–Contents: Tank 7–Contents: 11 0 El <br /> Tank 3–Contents: Tank 8–Contents: ❑ <br /> Tank 4–Contents: El ?J:P:�Ta.k 9�–C..te�nts ���� <br /> Tank 5–Contents: Li 1:11 Lj I T..L-10—Contents: ❑ El El <br /> 8 <br /> Tank <br /> containment areas are free of water,debris,and hazardous substance. Sensors are located properly. <br /> –'W-- – <br /> Y N /A Y N N/A <br /> Dispenser <br /> s 1 <br /> ispenser# 1 —9 Dispenser# E3 0 El <br /> Dispenser# IA&2 Dispenser# El <br /> DEl <br /> Dispenser# 2A&3 Dispenser# <br /> Dispenser# 3A&4 Dispenser# El 0 El <br /> Dispenser# 4A&5 Dispenser# _ri El 11 <br /> Dispenser#5A Dispenser# El El El <br /> Dispenser# <br /> Dispenser# El El [I <br /> P.O.BOX 401,W SACRAMENTO,CA 95691 (800)477-7266 <br />