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Village West Marina, 6649 Embarcadero Dr, Stockton, CA <br />DESIGNATED UNDERGROUND 5 i UNAUE TANK (UST) <br />OPERATOR MONTHLY VISUAL INSPECTION CHECKLIST <br />Villa1 c �'cst h4arintt Stockton, Datc: CA -95-2-19 <br />Facility Name: <br />Facility Address: 6649 Embarcadero Drive <br />Designated UST Operator: <br />inspector Signature: <br />international Code Council Certification #: ��G3 -5—u i Expire Date: <br />inspector Phone:<» <br />MONITORING PANEL / ALARM IfISTOR <br />I. Monitor system is powered on and in proper operating mode: Yes <br />2. Monitor system in "not" currently showing any alarms/warnings: Yes No NA <br />3. Alarm history report log for the previous month is available: Ye --No v',� <br />4. History report/log has been reviewed by designated inspector: Yes -No _ N/ A <br />5_ Each slam, for the previous month has been responded to appropriately: Yes _ No _ NiA <br />f • Sensors located in tank -top containment sumps have not alarmed in last month: Yes _ No _ NiA _ <br />5a List all sensors where alarms occurred in the past month: Yes _ No _ NtA <br />t NOTE: Sumps where an alar has occurred in the past month must be inspected unless a qualifted service technician resix nded <br />1 ) to, and properly addressed, the cause of the alar. Attach documentation verifying appropriate service to this rctx)rt. <br />r rfsump inspection is required, record results in item 6 (below). <br />1 ST SYSTEM INSPECTIO <br />6. Tank top containment sumps are free of water, debris, and hazardous substances. Sensors are located propert) <br />NOTE: Visual inspection orsutnps is only required in sumps where an alarm has oceurred in the past month fm which there is no . m- ca:wd <br />+#i•Fii....*tit. i........iii##1+lti F+...*.....* ................ .+...iii+int..........................• <br />Premium Unleaded Sump: Yes ----No = N/A= Diesel sump: Yes —No — N%A _ <br />Manifold Sump: Yes!'No N/A <br />Fisii#i#if#!i»iii##ttiiiiii»i+#tt#!#i atiiiak#itiiiti»i!#at4fiiiia+fat+♦iiiit.Y......................... <br />7. Spill containment structures (srou,�ports) are free of water, debris, and hazardous substances: <br />Premium Unleaded Fill: Yes _ No _ N/A _ Vapor: Yes _ No — NIA — <br />Diesel Fill Fill: Yes rNo N/A <br />ti»#riii+aii+4#aaaii»ii»#iii#ii#aaaa♦tiii###441iii+raaftiiaiariaaii•irir4t.arls..i...ia.•i..fi.•a•••.•• <br />8. Under -Dispenser containment areas are free of water, debris, and hazardous substances. Sensors are fixated properly. <br />Dispenser 1 Premium: Yes --" No <br />Dispenser 2 Premium: Yes No <br />Dispenser 3 Diesel: Yes No <br />PAPERWORK INSPECTIO <br />9. Monitoring system certification has been completed within past 12 months: Yes --"No _ N/A ^ Date: <br />10.2ndary containment tests have been completed within required time frame: Yes _� No _ N/A _ Datc: v tt' <br />11. Spill containment structure (bucket) testing completed within past year: Yes No — N/A <br />12. Tank tightness testing was completed within required time frame: Yes _ No _ N/A —Date* <br />13. Line tightness testing was completed within required time frame: Yes _ No _ N/A _Date: <br />ting maintenance was completed with required ti <br />April 2014 monthly D.O report with incorrect secondary containment test date <br />Page 12 of 28 Photo taken on March 16, 2015 <br />