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Village <br />West Marina, 6649 Embarcadero Dr, <br />Stockton, CA <br />Designated Underground Storage T (UST) Operator <br />fI <br />Monthly Visual Inspection hecklist <br />/ <br />Facility[Jame: r / fi Dale <br />1 <br />IflClll Address* M <br />City: <br />Designated UST O erotor Conductingthe Inspection: GREG KAISER <br />cation #: 5252318 Ex tion Date: O <br />International Code"re'm <br />Sia-nature:Pho 209 887-2839 <br />Y = Yes, N = Na, NA <br />= Not A livable <br />ItemMONITORING PANEL / ALARM STORY <br />Y N NA <br />i <br />I Monirorin ------ red on and in proper operating mode0andhas <br />2 Monirorin surrent) showing an alarms or w3 <br />Alarmhistoryr the previous month is available,een reviewed by the <br />Desi rated U(Attach a co o the alarm histo!o to this orm i available.)4 <br />Each alarm for the revious month has been res onded to a <br />5 Sensors located in tank -to containment sum s have not alaast month. <br />Y <br />5a - List all tank -top sumps where alarms occurred in the past month: <br />Note: Sumps where an alarm has occurred in the past month must be Inspected <br />property addressed, the cause of the alarm. Attach documentation wring apt <br />I/sump mspeaion is required, record results in item 6, below. - <br />UST SYSTEM INSPECTI <br />6 1 Tank -top containment sumps are free of water, debris, and hazardot <br />Note: Yisva/ inspection o sum s is only required in sum s where an alarm has o[ <br />Y N <br />Sump Location: Sump L <br />Sump Location: Sump L <br />Sump Location: Sump L <br />7 Spill containment structures are free of water, debris, and hazardou <br />Y I N I NA <br />a gital(fied service technician responded to, and <br />re service to this report. <br />etance. Sensors are located prol <br />in the past month for which there is no <br />Tank 1 - Contents: ?� Tank 3 - ontents: <br />Tank 2 - Contents: X Tank 4 - ontents: <br />8 Under-dis enser containment areas are free of water, debris, and ba dons substance. Sensors are located <br />Y N NA Y <br />NA <br />Dis ensex3Lf )c Dis ense 30 / 31 <br />Dispenser ' Dis ense 3 7 / 35 <br />Dispenser 2 -3 -4 -it Dis ense <br />Dispenser 27 / 25 Dis ease <br />PAPERWORK INSPECTION I Y N NA DATE DONE <br />9 Monitoring system certification has been completed within past 12 m nths. —13--e <br />10 Secondary containment tests have been completed within the requirej requiretimeframe. 3 -N A <br />11 Spill containment structure (bucket) testing was completed within thelpast ear. 114 <br />12 Tank tightness testin& was completed within required timeframe. <br />13 Line tightness testing was completed within required timeft-ame,-- <br />J14 Other re uired testis maintenance was completed within requiredtiefhame_r(List test/maintenance items below.) <br />Test/Maintenance. _ �-- <br />Maintenance: - - - -- -- — - <br />October 2014 monthly D.O report with incorrect secondary containment test date <br />--I <br />Page 6 of 28 Photo taken on March 16, 2015 <br />