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Village West Marina, 6649 Embarcadero Dr,- Stockton, CA <br />Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />Facility Name: VILLAGE WEST MARINA Date:q-9_ <br />Facilitx Address: 6649 EMBARCADERO DRIVE <br />ZY <br />City: STOCKTON Zi Code: 95219 <br />Designated UST O crator Conductin g the Inspection: GREG KAISER <br />_International Code n I ertification tt: 5252318 Ex iration Date: 10/152015 <br />Signature: Phone: ( 209 ) 887-2639 <br />Y=v— -4 NA Na =.._. .__. <br />I hell) ! V, MONITORING PANEL /ALARM HISTORY <br />I j h fonitonm; system is powered on and to proper operating mode. <br />Monitoring system is not currently showing any alarms or warnings <br />Alarm history report/log for the previous month is available, and has been reviewed by the <br />Designated UST Operator. (Attach a copy of the alarm history reportAog to this form ifati <br />4 Each alarm for the previous month has been responded to appropriately. <br />Sensors located in tank -top containment sumps have not alarmed in the past month. <br />53 - List all tank -top sumps ivhere alarms occurred in the past month: <br />Note: Sumps i;,here an alarm has occurred in the past month must be inspected unless a qualifiedsrvice technician responded to. and <br />properly addressed. the cause ojthe alarm. Attach documentation verifying appropriate service to tehis report. <br />tfsump inspeciranr is required record results in item 6 below <br />UST SYSTEM INSPECTION <br />6 1 ank-top contamment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note: I4isual inspection o stun s is only required in sum s where an alarm has occurred in the post month or which there is no service record. <br />Y N <br />Y N <br />Sunt Location: <br />Sunt Location: <br />Stun Location: <br />Sum Location: <br />Sum Location: <br />Sump Location: <br />7 Sill containment structures are free of water, debris, and hazardous substance. <br />Y N NA Y N <br />: <br />*Und,,-di,=pen,,, <br />y Tank 3 — Contents: <br />Eareas <br />: <br />Tank 4 —Contents: <br />S containment are free of water, debris, and hazardous substance. Sensors are located prope, <br />Y N NA Y N <br />Dis enser 7� / <br />Dispenser 30 / 31 <br />Dis enser ZLS-- <br />Dispenser 37 / 35 <br />Dis enser 2�2t- <br />Dispenser <br />Dispenser 27 / 25 <br />ni.cnvncor <br />P"ERWORK INSPECTION Y N NA Dn <br />[PM onitorin s stem certification has been cpm leted within ast 12 months, <br />econ containment tests have been con leted within the re uired timeframe. <br />ill containment structure bucket testing was cpm leted within the nast vear. u <br />12 Tank ti tness testing was completed within re uired timeframe. <br />13 _Line tightness testing was completed within required timeframe. <br />_14 1 Other required testing/maintenance was completed within re uired timeframe. List test/maintenance items <br />Test/Maintenance: <br />September 2014 monthly D.O report with incorrect secondary containment test date <br />I <br />below, <br />Page 7 of 28 Photo taken on March 16, 2015 <br />