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V <br /> Site ID: 1300-1 <br /> Afforda-Te$t <br /> 416 2nd Street Designated Operator <br /> Galt, Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: Van de Pal Lodi Pacific Pride Date: 1/29/10 <br /> 351 Beckman Road <br /> Lodi, CA <br /> Lyle 1). Nimmo Zone A.Nimmo David A.Winkler ❑Felix G.Ramirez <br /> #5249115 #5263322 #5263373 #5273934 <br /> Signature: <br /> I IN I'll���iimiilliiiliioiii IN 111 11111 <br /> MONITORING PANEL/ALARM HISTORY Y N NA <br /> Monitoring system is powered on and in proper op6r4tin mode, X <br /> Monitoring system is not currently showing any alarms or warnings. X <br /> Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator.(Attach a co Lf the alarm history reporyo-9 to this f <br /> orm#'avadable) <br /> Each alarm for the previous month has been responded to appropriately X <br /> Sensors located in tank-top containment sumps have not alarmed in the past month, X <br /> all tank-top sumps where alarms occurred in the past month: 91 STP SUMP HAS WATER INIT NOTIFIED SITE MAINTENANCE. <br /> XWe:Sumpt Were an alarm has occurred in the past mq.nFT must be inspected unless a gaal edservlce techntotan responded to,andproperly <br /> bddi,essed, the cause of the alarm.Attach documentation yoroing appropriate service to this report. If sump inspection is required,record results <br /> its item 6,below. <br /> UST SYSTEM XNSPECTION <br /> Y I N I E17 I Y N. NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance, Sensors are located properly. <br /> Note: swhere analarm has occurred in the pqsl month or which(hem is no service record I <br /> Sump Location; 87 STP--FILL X Sump Location: X <br /> Sump Location: 91 STP—FILL X Sump Location; X <br /> Sump Location; DIESEL 2 STP—FILL X Sump Location: X <br /> Spill!containment structures are free of water,debr4.:!&hazardous substance. <br /> Tank I -Regular X Tank 4-Diesel X <br /> Tank 2—Plus X Tank 5- <br /> Tank 3 -Premium X Tank 6- <br /> Under-die enser <br /> -Under-diseenser containment free of water,debris,&:hazardous substance.Sensors located 2roperly. <br /> Dispenser 1/2 X Dispenser 19/20 X <br /> Dispenser 3/4 X Dispenser 21 X <br /> Dispenser 5/6 X Dispenser 22/21 X <br /> Dispenser 7/8 X Dispenser 23/22 X <br /> Dispenser 9/10 X Dispenser 24/2.3 X <br /> Dispenser 11/12 X Dispenser 25/24 X <br /> X Dispenser 26/25 <br /> unser 13/14 X <br /> b,openser 15116 X Dispenser 27/26 Satellite X <br /> Dispenser 17/18 X Dispenser 27 X <br /> ZL 'd 65LL 01.0Z 6L jnr 016199V60Z:xeJ 10d 30 NVA <br />