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STATE OF CALIFORNIA•DEPARTMENT OF TRANSPORTATION <br /> CALTRANS MAINTENANCE STATION <br /> ABOVE GROUND STORAGE TANKS AND FUELING FACILITY <br /> HQ-MTCE-02(REV 811999) <br /> DAILY INSPECTION FORM <br /> DISTRICT: FACILITY NAME: CONTENTS OF TANK(S): <br /> 10 Stockton Yard Diesel,Gasoline,Propane <br /> PERMIT NO: DATE(MONTHNEAR): <br /> PT0009997 September 2017 <br /> CHECK FOR GOOD DAYS OF THE MONTH <br /> OPERATION CONDITIONS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25126 27 28 29 30 31 <br /> Tank(s) Leak Free x x x x x x x x x x x x x x x x x x x x x <br /> Hoses/Fittings Leak Free x x x x x x x x x x x x x x x x x x x x x <br /> Nozzles/Pumps Leak Free x x x x x x x x x x x x x x x x x x x x x x <br /> Fill Ports Spill x x x x x x x x x x x x x x x x x x x x x x <br /> Containment D <br /> Spill (Tertiary) x x x x x x x x x x x x x x x x x x x x x x <br /> Containment(Dry) <br /> Spill Containment Valve Closed x x x x x x x x x x x x x x x x x x x x x x <br /> Auto Shut-off Switch Posted x x x x x x x x x x x x x x x x x x x x x x <br /> Auto Shut-off Switch Operable x x x x x x x x x x x x x x x x x x x x x x <br /> Fueling Procedure Posted x x x x x x x x x x x x x x x x x x x x x x <br /> Spill Cleanup Procedure Posted x x x x x x x x x x x x x x x x x x x x x x <br /> Spill Kit(Essential Material x x x x x x x x x x x x x x x x x x x x x x <br /> Available <br /> Used Container(Lid Covered From x x x x x x x x x x x x x x x x x x x x x x <br /> Rain) <br /> Permit(s) Current x x x x x x x x x x x x x x x x x x x x x x <br /> Distribution: Original-District Hazmat Mgr. Pink-District Storm H2O Mgr. Yellow-Field Office <br /> ADA Notice For individuals with sensory disabilities,this document is available in alternate forMats. For alternate fo at information,contact theFor <br /> Management Unit at(916)445-1233,TTY 711,or write to Records and Forms Management,1120 N Street,MS-89,Sacramento,CA 95814. <br /> 1 <br />