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I�A'MOS <br />f .. � tOrc COMPANY <br />Facility Name:RAMOS OIG - FRECH CAMP <br />Facility Address:10842 S HARLAN RD <br />City/State/Zip:FRENCH CAMP/CA <br />Designated UST Operator.Samuel Delgado Phone:916-371-2570 <br />ICC Certification Number:1065203-uc Expiration Date: 2-25-2013 <br />Signature: Date: <br />Item <br />MONITORING PANEIdALARM HISTORY <br />Y <br />N <br />N/A <br />1 <br />Monitoring system is powered on and in proper operating mode. <br />& <br />9 <br />❑ <br />2 <br />Monitoring system is not currently showing any alarms or warnings. <br />❑ <br />❑ <br />3 <br />Alarm history report/tog for the previous month is available, and has been reviewed by the Designated UST Operator. <br />9❑ <br />4 <br />Each alarm for the previous month has been responded to appropriately. <br />❑ <br />5 <br />NINNNNOM <br />Sensors located in tank -top containment sumps have not alarmed in the past month. <br />Nate: 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 veru'in a ro nate service to this re oh. If sum ins ction is reuired, record results in item 6, below. <br />UST SYSTEM INSPECTION <br />❑ <br />❑ <br />6 <br />Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note: Visual inspection of sum s is only required in sumps where an alrm has occurred in the past month for which there is no service record. <br />Y I N N/A <br />Y <br />N <br />N/A <br />Sump Location: <br />❑ ❑ ❑ Sump Location: <br />❑ <br />❑ <br />❑ <br />Sump Location: <br />❑ ❑ ❑ Sump Location: <br />❑ <br />❑ <br />❑ <br />Sump Location: <br />❑ ❑ ❑ Sump Location: <br />❑ <br />❑ <br />Sump Location: <br />ET ❑ I ❑ I Sump Location: <br />❑ <br />7 <br />Spill containment structures are free of water, debris, and hazardous substance. <br />Y I N I N/A <br />Y <br />N <br />N/A <br />Tank 1 -Contents: DFC ❑ ❑ Tank 6 - Contents: <br />❑ <br />❑ <br />❑ <br />Tank 2 - Contents: ❑ ❑ ❑ Tank 7 - Contents: <br />❑ <br />Tank 3 - Contents: ❑ ❑ Tank 8 - Contents: <br />❑ <br />❑ <br />❑ <br />Tank 4 - Contents: ❑ ❑ ❑ Tank 9 - Contents: <br />❑ <br />❑ <br />❑ <br />Tank 5 - Contents: ❑ ❑ ❑ Tank 10 - Contents: <br />❑ <br />❑ <br />❑ <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N N/A <br />N <br />N/A <br />Dispenser # 1 E] E] Dispenser # <br />Dispenser # 1A & 2 `� r El [IDispenser # <br />r[D <br />ElDispenser <br /># 2A & 3 ,❑ ❑ Dispenser # <br />FEI <br />❑ <br />Dispenser # 3A&4 j [I ElDispenser # <br />❑ <br />❑ <br />Dispenser # 4A & 5 ❑ ❑ Dispenser # <br />❑ <br />❑ <br />❑ <br />Dispenser #_5A- ❑ ❑ Dispenser # <br />❑ <br />❑ <br />❑ <br />Dispenser # ❑ ❑ ❑ Dispenser # <br />❑ <br />❑ <br />❑ <br />P.O. BOX 401, W SACRAMENTO, CA 95691 (800) 477-7266 <br />