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R�CBVED <br />Attachment 5 OCT 2 3 2017 <br />TANK INSPECTION CH ECKLISTENVI RON MENTAL HEALTH <br />Page 2 of 4 <br />L1tF'HH 1 Mr—IN 4 <br />FACILITY NAME: <br />FACILITY LOCATION: �� CI, S• (i Lv <br />// r-3 77 <br />INSPECTION DATE: 119 • (o �� <br />4.0 <br />Signs of spills or leaks from tank or associated piping? <br />❑ Yes No <br />❑ NA <br />4.1 <br />Has the facility had any major spills? <br />❑ Yes No <br />❑ NA <br />4.2 <br />Contaminant of concern in major spill? <br />4.3 <br />Is the soil contaminated? <br />❑ Yes ❑ No <br />d NA <br />4.4 <br />Contaminant of concern in soil? <br />4.5 <br />Is the ground water contaminated? <br />❑ Yes ❑ No <br />NA <br />4.6 <br />Contaminant of concern in ground water? <br />4.7 <br />Is there a ground water monitoring system? <br />❑ Yes Ja No <br />❑ NA <br />4.8 <br />Number of monitoring we <br /> <br /> +'V <br />k'2 <br />4.10 <br />Frequency of monitoring? ❑ Daily Weekly ❑ Monthly ❑ Other: <br />5.0 <br />Ongoing cleanup? <br />❑ Yes ❑ No <br />i111 NA <br />5.1 <br />Organization doing cleanup? Facility: ❑ Yes ❑ No <br />Outside Group: ❑ Yes ❑ No If yes, identify group: <br />5.2 <br />Ongoing investigation? <br />❑ Yes ❑ No <br />� NA <br />5.3 <br />Which agency is acting as lead for cleanup? Facility: ❑ Yes <br />Outside Group: ❑ Yes ❑ No If yes, identify group: <br />❑ No <br />6.0 <br />Has the SWRCB ever inspected the site? ❑ Yes ❑ No If yes, date: <br />6.1 <br />Name of SWRCB contact person? . <br />.2 <br />6.2 <br />Has the -EPA ever inspected the site? ❑ Yes ❑ No If yes, date: <br />6.3 <br />Name of EPA contact person? <br />7 <br />7.0 <br />Is the SPCC Plan available during working hours? Yes ❑ No <br />7.1 <br />Discuss any questions from your review of the SPCC Plan: <br />BACC1602.DBC-Z22-TRACY <br />