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FACILITY INSPECTION CHECKLIST <br />Page <br />FACILITY NAME AND ADDRESS <br />Clements'! 7300 E. Jahant Rd. <br />Clements, CA <br />Date of Inspection <br />From: 06/04/2018 To: 06/04/2018 <br />2. Any signs <br />GENERAL INFORMATION <br />Designated Person Accountable for Spill Prevention: <br />5. Are <br />valves, <br />General Photo: <br />Before / After Photo: <br />FACILITY INSPECTION CHECKLIST <br />Aboveground storage tanks, and <br />foundations <br />1. Any signs <br />2. Any signs <br />3. <br />Containers <br />4. Is <br />secondary <br />5. Are <br />valves, <br />6. Notice <br />any spills <br />7. Are Pipes <br />8. Flex <br />a <br />® Yes E]No <br />Date <br />of leaks on <br />container <br />of rusting, <br />within or on <br />containment <br />fittings and <br />inside of <br />and hoses <br />joints/hoses <br />Comments /Corrective Actions <br />surface or <br />corrosion, <br />secondary <br />free of <br />gaskets are <br />secondary <br />properly <br />are properly <br />pitting etc.? <br />containment <br />liquid, debris <br />free from <br />containment <br />secured? <br />secured? <br />n <br />? <br />or objects? <br />leaks? <br />? <br />c <br />Clements Facility X <br />6/4/2018 <br />No <br />No <br />Yes <br />Yes <br />Yes <br />No <br />Yes <br />Yes <br />Cory <br />+ <br />(Part A) <br />0 <br />' <br />Hoses, Pipes, & Support <br />❑ Yes ❑ No <br />Pumps and Valves <br />❑ Yes ❑ No <br />Dispensers <br />❑ Yes ❑ No <br />Connections, Joints and Fitting <br />seals <br />❑ Yes ❑ No <br />Interstitial spaces of double walled <br />tanks <br />❑ Yes ❑ No <br />Liquid level gauges for tanks <br />1. Is the gauge <br />2. Any signs of <br />® Yes F-1Noleaks? <br />Date <br />readable and in <br />Inspected by <br />Comments /Corrective Actions <br />good condition? <br />Clements Facility (Part X <br />+ <br />6/4/2018 <br />Yes <br />No <br />Cory Turney <br />8) <br />Fence & Gates <br />❑ Yes ❑ No <br />