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Site ID: 1300 <br /> Afor da-TeSt <br /> 416 2Id Street Designated Operator <br /> Gait, Ca 95632 Monthly Inspection Cheeldist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site; VAN DE POL LODI PACIFIC PRIDE Date: 06-08-10 <br /> 351 N BECKMAN ROAD <br /> LODI CA 95240 <br /> ❑ Lyle D.Nimmo ❑Zone A.Nimmo ❑David A.Winkler Felix G.Ramirez <br /> #5249115 #5263322 #5263373 #5273934 <br /> Signature*: <br /> I liiiimiiiiiiiiliillillillill� III 1111111111i"'Jill V=yes N-no.NA=not appliefible <br /> MONITORING PANEL ALARM HISTORY Y N NA <br /> Monitoring system is powered on and in proper operating mode, XX <br /> Monitoring system is not currently showing any alarms or warnings. <br /> Alarm history repo log for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator. (Attach a co of the alarm h1sLq2 re ortl to this arm javailable. <br /> .Io <br /> Each alarm for the previous month has been responded to appropriately <br /> ..S,ensors located in tank-top containment sumps have not alarmed in the past month, <br /> all tank-top sumps where alarms occurred ifi,the past month: <br /> Note.Amps where an OTarm—has occurred hi the past mons tartest—musibe inspected unle—us a qualified service technician responid_ed to,and proper,y <br /> the cause of the alarm.Attach documentation verifying appropriate service to this report.tfsump inspection is required,record resulls <br /> In item 6, below. <br /> UST SYSTEM INSPECTION <br /> Y N N NA <br /> I I I RTT <br /> Tank-top containment sumps are free of water,d6bris,and hazardous substance. Sensors are located properly. <br /> Note., Visual IMCtion of sum Is only re idred in sum ighere an alarm has occurred in the pa 22!gh <br /> �®r which then is no service record <br /> Sump Location: 87 X Sump Location: <br /> Sump Location:91 X Sump Location: <br /> Sump Location:die/red X Sump Location: <br /> --- -—1 1 11111111111 Jill 11 '111 <br /> Spill containment structures are free of water,de6ils,&hazardous substance. <br /> Tank I -Regular Tank 4-Diesel _X <br /> Tank 2–Plus x Tank 5- <br /> Tank 3 -Premium X Tank 6. <br /> Under-dispenser containment free of water,debris,&hazardous substance.Sensors located properly. <br /> Dispenser 1/2 x Dispenser 19/20 X <br /> Dispenser 3/4 X Dispenser 21 <br /> Dispenser 516 X Dispenser 22/21 X <br /> Dispenser 718 X Dispenser 23/22 <br /> Dispenser 9/10 X Dispenser 24/23 <br /> Dispenser 11/12 Dispenser 25/24 <br /> denser 13114 Dispenser 26/25 <br /> Dispenser 15/16 _JDispenser 27/26 Satellite F <br /> Dispenser 17/18 _TDispenser 27 <br /> ZZ 'd CO:Zl. 01.0Z 6L Inp 016199V60Z:xeJ 10d 30 NVA <br />