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06/29/2005 13:55 2099519352 VILLAGE WEST MARINA PAGE 02 DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR MONTHLY VISUAL. INSPECTION CHECKLIST Facility Name: Village West Marina Date: 170 -pc 45-. zczs Facility Address: 6649 Embarcadero Drive Stockton, CA95219 Designated USI' Operator: )C7^ 111e,44y Inspector Signature: . International Code Council Certification 4. yam' - Expire Date: //-/,?-0e1'OrQ Inspector Phone: UST SYSTEM INSPECTIO 6. Tank to water. debris and hazardous substances. Sensors are lot NOTE ;steal i where analarm tsas occurred int past month for which them is no service record. WWWWWWWr WrrrtwWwWWWWrrilWrtrtittistttrttr►rrtt 1tt►rrr Premium Unleaded Sump: Yes No N/A k� Diesel sump: Yes _ No _wA Manifold Sump: Yes — No N/A j Rrrrrrwr...rtr.rtrrr.rt wrr.sirs!r.rrrrrr.r.rrrrrrrrrrrrrrryr�V*%Kl ttttRtwrRtrrrrrrrrrrrrrwrrwwiWti Wtttii 7. Spill containment structures (grottund ports) are free of water, debris, and h:uardous su !antes; Premium Unleaded Fill: Yes No N/A Vapor: Ye _ No— NIA Diesel Fill Fill: Yes_ No N/A,-- ..................... W4rWW 8. Under -Dispenser containment areas are free of water, debris, and hazardous substances. Sensors are located properly. Dispenser 1 Premium: Yes No Dispenser 2 Premium: Yes No Dispenser 3 Diesel: Yes No AFERWORK INSPb'CTIO,, 9. Monitoring system certification has been completed within past 12 months: Yes � No _ N;A — Date; �� O•I 10. 2ndary containment tests have been completed within required time tune.; Yes No _ N/A—Date: /B�Zg't7 11. Spill containment structure (bucket) testing completed within past year: Yes No _ N/A _ Date: /0 12. Tank tightness testing was completed within required time frame: Y 0 _ N/A _ Date ,IO–Y' 13, Unc lightness testing was completed within required time frame: Yes —No N/A — Date; 14. Other required testing maintenance was, completed with required tirnefrattle (List tcwmaintenancebelow): trrrtwirrrrtwtrwttttdltttttrittttiiiWtttttiittttttiitttttttrrtktirrrtwrrww WrtititlttttitttirrtttrwWttWit ACILITY EMPLOYEE TRAININ �` 15, All facility employees have received the required on-the-job training within the past year; Yes JkNo — N/A 16. All employees hired within the past 30 days have received the required on•the-job training: Yes — No — N/A� NOTE: Any answer "NO" should be explained In the comments on the following page, and requires follow-up action. (Page 1 of 2) MONITORING / ALARM OR 1. _ Monitor system is powered on and in proper operating mode: Yes,e No _ N/A 2. Monitor system in "not" currently showing any alarms/warnings; Yes No -N/A 3. Alarm history report/log for the previous month is available: Yes Tc No _ N/A _ 4. History report/log has been reviewed by designated inspector: Yes No —N/A 5- Each alarm for the previous month has been responded to appropriately' Yes _ No — N/A • Sensors located in tank -top containment sumps have not alarmed in last month' Yes No _ N/A 5a List all sensors where alarms occurred in the past month; Yes _ No _ N/A NOTE: Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to, and properly addressed, the cause of the alarm. Attach documentation ve'r'ifying appropriate service to this report, If sump inspection is required• record results in item 6 (below) UST SYSTEM INSPECTIO 6. Tank to water. debris and hazardous substances. Sensors are lot NOTE ;steal i where analarm tsas occurred int past month for which them is no service record. WWWWWWWr WrrrtwWwWWWWrrilWrtrtittistttrttr►rrtt 1tt►rrr Premium Unleaded Sump: Yes No N/A k� Diesel sump: Yes _ No _wA Manifold Sump: Yes — No N/A j Rrrrrrwr...rtr.rtrrr.rt wrr.sirs!r.rrrrrr.r.rrrrrrrrrrrrrrryr�V*%Kl ttttRtwrRtrrrrrrrrrrrrrwrrwwiWti Wtttii 7. Spill containment structures (grottund ports) are free of water, debris, and h:uardous su !antes; Premium Unleaded Fill: Yes No N/A Vapor: Ye _ No— NIA Diesel Fill Fill: Yes_ No N/A,-- ..................... W4rWW 8. Under -Dispenser containment areas are free of water, debris, and hazardous substances. Sensors are located properly. Dispenser 1 Premium: Yes No Dispenser 2 Premium: Yes No Dispenser 3 Diesel: Yes No AFERWORK INSPb'CTIO,, 9. Monitoring system certification has been completed within past 12 months: Yes � No _ N;A — Date; �� O•I 10. 2ndary containment tests have been completed within required time tune.; Yes No _ N/A—Date: /B�Zg't7 11. Spill containment structure (bucket) testing completed within past year: Yes No _ N/A _ Date: /0 12. Tank tightness testing was completed within required time frame: Y 0 _ N/A _ Date ,IO–Y' 13, Unc lightness testing was completed within required time frame: Yes —No N/A — Date; 14. Other required testing maintenance was, completed with required tirnefrattle (List tcwmaintenancebelow): trrrtwirrrrtwtrwttttdltttttrittttiiiWtttttiittttttiitttttttrrtktirrrtwrrww WrtititlttttitttirrtttrwWttWit ACILITY EMPLOYEE TRAININ �` 15, All facility employees have received the required on-the-job training within the past year; Yes JkNo — N/A 16. All employees hired within the past 30 days have received the required on•the-job training: Yes — No — N/A� NOTE: Any answer "NO" should be explained In the comments on the following page, and requires follow-up action. (Page 1 of 2)