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- SPCC ANNUAL INSPECTION FORM <br /> Facility: California Health Care Facility <br /> 7707 South Austin Road Date: <br /> Stockton, CA 95215 Completed By: <br /> Title: <br /> (Yes /No) <br /> 1. ASTs: (Diesel Fuel and various Drums) <br /> A. Has the monthly inspection been done for the tanks each month? <br /> B. Are the tanks in good condition? <br /> C. Are the spill kits in place and stocked with proper supplies? <br /> 2. Inspections, Testing and Records: <br /> A. Do the required inspections follow written procedures? <br /> B. Are the written procedures and a record of inspections signed by <br /> the appropriate supervisor or inspector available? <br /> C. Was tank or piping testing required based on evidence of a leak or <br /> the Industry Standard schedule? If yes, describe below. <br /> D. Was a functionality test performed on all gauging and monitoring <br /> equipment to verify proper operability? Provide the date of testing. <br /> E. Was testing performed on direct vision gauge liquid level sensing devices per <br /> Section 5.2.8 and did the test confirm the gauge readings? Provide the date of <br /> testing. <br /> F. When was oil last removed from the oil/water separator? If within <br /> the last month, attach the manifest. <br /> G. Are there three (3) years of inspection and testing records onsite? <br /> 3. Personnel, Training and Spill Prevention Procedures: <br /> A. Oil-handling personnel are properly instructed in the following (check all that <br /> apply): <br /> Date of training: <br /> (1) Operation and maintenance of equipment to prevent oil discharges <br /> (2) Applicable pollution control laws, rules and regulations <br /> (3) Use of applicable spill control equipment and materials <br /> (4) Inspection procedures <br /> (5) New precautionary measures <br /> B. Is the training log up-to-date (Yes/No)? If No, explain. <br /> 8411599 <br />