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DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <br />MONTHLY VISUAL INSPECTION CHECKLIST <br />Facility Name <br />New West # 1003 <br />Date July 30, 2009 <br />Facility address <br />6437 W. Banner Road <br />City, State, Zip <br />Lodi, CA 95242 <br />Note: Visual inspection of sumps is only required in sumps where an alarm has occurred in the past month for which there is no service record. <br />Designated Operator <br />Fast, Alex <br />ICC Certification # <br />5307848 -UC <br />Expiration March 24, 2009 <br />Signature <br />Sump Location: ❑ ❑ Sump Location: <br />Phone (916) 869-0023 <br />UST SYSTEM INSPECTION <br />6 Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note: Visual inspection of sumps is only required in sumps where an alarm has occurred in the past month for which there is no service record. <br />Y N <br />Y <br />N <br />Sump Location: ❑ ❑ Sump Location: <br />❑ <br />❑ <br />Sump Location: ❑ ❑ Sump Location: <br />❑ <br />❑ <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />Y N NA <br />Y <br />N <br />NA <br />Gasoline - 87 E ❑ ❑ 1 Diesel <br />0 <br />❑ <br />❑ <br />Gasoline - 91 0 ❑ ❑ <br />❑ <br />❑ <br />❑ <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N NA <br />Y <br />N <br />NA <br />Dispenser 1/ 2 ❑ ❑ Dispenser 11 / 12 <br />0 <br />❑ <br />❑ <br />Dispenser 3 / 4 ❑ ❑ Dispenser 13 / 14 <br />0 <br />❑ <br />❑ <br />Dispenser 5 / 6 ❑ ❑ Dispenser 15 / 16 <br />❑ <br />❑ <br />Dispenser 7 / 8 ❑ ❑ <br />❑ <br />❑ <br />❑ <br />Dispenser 9 / 10 M ❑ ❑ <br />❑ <br />❑ <br />❑ <br />© 2007 — Page 1 Checklist P1 <br />