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• <br />Afforda-Te$t <br />416 2nd Street <br />Galt, Ca 95632 <br />209-744-0112 Fax 209-744-0116 <br />Site: VAN DE POL - LODI PACIFIC PRIDE <br />351 BECKMAN RD <br />LODI, CA 95240 <br />❑ Zane A. Nimmo <br />#5263322 <br />❑ David A. Winkler <br />#5263373 <br />W <br />0 <br />Site ID: 1300-1 <br />Designated Operator <br />4Iy Inspection Checklist <br />Date: 5-12-17 <br />JUN 2, 3 2017 <br />ENVIRONMENTAL HEALTH <br />- DFPARP,,,4ENT <br />❑ Felix G. Ramirez ® Edward Stearns <br />#5273934 #5250492 <br />v=.mc N=on NA—nnf 9nnl:ro6la <br />MONITORING PANEL / ALARM HISTORY <br />Y <br />N <br />NA <br />Monitoring system is powered on and in proper operating mode. <br />X <br />Monitoring system is not currently showing any alarms or warnings. <br />X <br />Alarm history report/log for the previous month is available, and has been reviewed by the Designated UST <br />Operator. Attach a copy qf the alarm history report/logreportllog to this form i available. <br />X <br />Each alarm for the previous month has been responded to appropriately <br />X <br />Sensors located in tank -top containment sumps have not alarmed in the past month. <br />X <br />List all tank -top sumps where alarms occurred in the past month: <br />Note: Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to, and properly addressed, <br />the cause of the alarm. Attach documentation verifying appropriate service to this report. If sump inspection is required, record results in item 6, below. <br />UST SYSTEM INSPECTION <br />Y I N I NA I I Y I N NA <br />Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note: Visual inspection ofsump is only required in sum s where an alarm has occurred in the past month for which there is no service record. <br />Sump Location: <br />Sump Location: <br />Sump Location: <br />Sump Location: <br />Sump Location: <br />containment structures are free of water, debris, & hazardous substance. <br />—Spill <br />Tank 1 - Regular X Tank 5 -RED DIESEL X <br />Tank 2 — Plus X Tank 6 -DIESEL 2 X <br />Tank 3 - Premium X Tank 7- X <br />Tank 4 — Diesel 1 X Tank 8- X <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 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 24/23 X <br />Dispenser 11/12 X Dispenser 25/24 X <br />Dispenser 13/14 X Dispenser 26/25 X <br />Dispenser 15/16 X Dispenser 27/26 Satellite X <br />Dispenser 17/18 X Dispenser 27 X <br />