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Site ID: 1300-1 <br /> y fox a-Tet <br /> 416 2nd street Designatedgator <br /> Gait, CA 95632 Monthly Inspection; Cheddist <br /> 209-744-0112 Fax 209-7440116 <br /> i <br /> Site: VAN DE POL -- LODI PACIFIC PRIDE j Date: 4/29/10 <br /> 351 BECKMAN RD. <br /> LODI, CA 95240 <br /> ® Lyle D.Nimmo ®?ane A.Nimtao; ❑David A.Winkler ❑Fen: G.Ramirez <br /> 05249115 #5263322 #5263373 ;#8273934 <br /> Signature: <br /> Wes ea N=ao,NA nota lieable <br /> MONITORING PANEL 1 A4LARM HISTORY Y I N NA <br /> Monitoring system is powered on and in proper operating mode. X <br /> Monitoring system is not currently showing any alarms or wWmings. X <br /> Alarm history report/log for the previous month is'available,Ond has been reviewed by the Designated UST X <br /> Operator.(Attach a EM o the alarm history rfRortllog to this}form i avallablej <br /> Foch alarm for the previous month has been responded to app opriately x <br /> ;ors located in tank-top containment sumps have not alamt ed in the past month, x <br /> List all tank-top sumps where alarms occurred in the past month:SITE MAINTINANCE REMOVED RAIN WATER <br /> Pole:Sumps w?ere an alarm has occurred In the post month must 6o inspected unless a qualUtid service teC niclan respon ed to, and properly <br /> addressed,the cause of the alarm.Attach documentaltoh verifying appropriate service to this report.If sump Inspection is required,record results <br /> in item 6,below, <br /> USTSYS M INSPECTION <br /> Y NA Y N NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance,Sensors are located properly. <br /> Note: Nisual Ins coon o sum s is only re hired In slim s,vherei an alarm has occurred in the=1 month or which there,is no service record, <br /> Sump Location: $?FILL SUMP X Sump Location; $? STP SUMP X <br /> Sump Location:91 FILL SUMP X Sump Location:91 STP SUMP X <br /> Sump Location:DIESEL FILL SUMP X Sump Location:DIESEL STP � X <br /> Sump Location: RED DIESEL FILL SUMP . X Sump Location:RED DIE STP; x <br /> Sump Location,DIESEL A-B FILL SUMP X Sump Location:DIE A-B PIPE! Xs.;�;,' <br /> Ill 10 1111 Jim <br /> Spill containment structures are free of water,debris &hazardous substance. <br /> Tattle 1 -Regular X Tank 5-RED DIESEL X <br /> Tank 2—Plus X Tank 6-DIESEL A-B X <br /> Tank 3 -Premium X Tank 7- <br /> Tank 4-Diesel X Tank 8- <br /> Under-dispenser containment free of water,debris,&hazardous substance. Sensors located 2ro <br /> Dispenser 1/2 x Dispenser 19/20 X <br /> r nenser 3/4 X Dispenser 21 <br /> X <br /> .,denser 5/6 X Dispenser 22/21 X <br /> Dispenser 7/8 X Dispenser 23/22 X <br /> Dispenser 9/10 x Dispenser 24/23 <br /> X <br /> Dispenser 11/12 x Dispenser 25/24 X <br /> Dispenser 13/14 X Dispenser 26/25 X <br /> Dispenser 15/16 Disienser 27/26 Satellite x <br /> Dispenser 17/18x Dispenser 27 X <br /> 81 'd ZO:Z1 OIOZ 61 InP 016199V60Z:Xe4 10d 10 NVA <br />