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/•1 <br />Yt- <br />rte <br />West Marina, m49 Embarcadero Dr, Stockton, CA <br />Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />racilrn Name VILLAGE WEST MARINA Dat,: - j —! 4 <br />Facility Address: 6649 EMBARCADERO DRIVE Zip Code: 95219 <br />Cth STOCKTON <br />Desienat,d tiST O erat r Conducting the Ins ection. GREG KAISER <br />t corle CO&hcli Cdenincation r:: 5252318 1 Expiration Date: 10/152015 <br />r; vr(IIViTnunVG PANEL/ALARM HISTORY i Y N `.> 1 <br />1 . 1Vtonitorine vstem is powered on ano to propero eraurru 1 <br />t4onitorinn system is not currentlZ showing an), alarms or warnings. I I <br />3 Alarm history reporulog for the previous month is available, and has been reviewed by the <br />Designated UST Operator. /Attach a cop2 o the alarm history reEortllog to this form ifavadable.! <br />4 Each alarm for the previous month has been res onded to approlanately. <br />t $ensots located in tank -ton containment sum shave not alarmed in the past month.'i <br />Sa _ List all tonk-top sumps where alarms occurred in the past month: <br />Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to. and <br />Jproperly addressed the cause ofthe alarm. Attach documentation rertfy'mg appropriate service to this report. <br />/Jsunp rasp •man s required record rendts in item 5 below. <br />UST SYSTEM INSPECTION <br />Tank -top containment sumps are free of -water. debris, and hazardous substance. Sensors are located properly. <br />! V /urs ection o sttnr s is only required in sum s where an alarm has occurred in the DaSt month for which there is no se—ce record <br />a e. rsua <br />Y <br />N <br />Sump Location: <br />unr ocation: <br />SL <br />Sump Location: <br />SwnD Location: <br />Sump Location: <br />.:�i SumD Location. <br />7 S ill containment structures are free of water, debris, and hazardous substance. <br />Y <br />N NA <br />Tank 1 - Contents: <br />Tank 3 - Contents: <br />Tank 2 - Contents: <br />? <br />Tank 4 -Contents: <br />S Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are <br />Y <br />N NA <br />Dis enser 4•: 1 <br />Dispenser 30 / 31 <br />Dis enser- 5• <br />Dis enser• 37 / 35 <br />Dispensers <br />) �` ! \ <br />Dispenser <br />DispenS"-27125 <br />Dispenser <br />PAPERWORK INSPECTION Y N NA <br />9 Monitorin s stem certification has been completed within ast 12 months. <br />10 Secondary containment tests have been completed within the required timeframe. 1 <br />11 S ill containment structure (bucket) testin was completed within the ast ear. <br />12 Tank ti fitness testin was com feted within re wired timeframe. <br />13 Line ti tness testin was com leted within re uired timeframe. <br />DATE DONE <br />LA <br />14 Other required testing/maintenance was completed within required timeframe. (List test/maintenance items below.) <br />TesdMaintenance: <br />June 2014 monthly D.O report with incorrect secondary containment test date <br />Page 10 of 28 Photo taken on March 16, 2015 <br />