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ATTACHMENT 4 <br /> APPENDIx B <br /> AST MONTHLY INSPECPION CHECKLIST <br /> SPCC PLAN <br /> Stockton Police Department <br /> 22 East Market Street <br /> Stockton,California 95206 <br /> 6,000-gallon Gasoline AST <br /> This AST inspection record must be completed monthly. Completed forms are to be maintained in the SPCC Plan <br /> file. Inspection responses with'yes'requires comments in the Description&Comments spaces provided and in the <br /> Remarks section,as needed. Use additional sheets as necessary. Tank discrepancies must be reported immediately <br /> to the SPPC Plan Designated Person. <br /> 6,000-gallon Gasoline AST INSPECTION DATE: <br /> Yes No N/A Description&Comments <br /> Tank exterior surfaces show signs of leakage? <br /> Surface beneath tank shows signs of leakage? <br /> Annular space containsgasoline? <br /> Tank,vents,gauges,hoses show signs of <br /> damage,rust,or deterioration? <br /> Vents are obstructed? <br /> Valves,seals,pump or gaskets leaking? <br /> Dispensing hoses/piping damaged or / <br /> deteriorating? 1/ <br /> Clock Gauge functioning? <br /> Emergency Shut-Off switches functioning? <br /> Other <br /> Remarks: <br /> Inspector's Signature: Date: <br /> Plan DP Signature: Date: <br />