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Village West Marina, 6649 Embarcadero Dr, Stockton, CA <br />P_acifil, Name: <br />Fncilin Addrea <br />S i ett atu re: <br />Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />AGE WEST MARINA Date: <br />EMBARCADERO DRfUE <br />rKTON Zip Code: 95219 <br />^---..-••^^ the inspecuon GRE(; KAISER <br />m 0: 5252318 <br />Expiration Date: I <br />Phone: ( 209 ) 81 <br />PANEL/ALARM HISTORY <br />5 <br />I Monitoring system is powered on and in 1.0er operating mode. <br />Mon itorin System is not cu7ritl y showing any alarms or warnings. >` <br />3 Alarm history report/lo� for the previous month is available, and has been reviewed by the X <br />Designated UST operator. (Attach a co , of the alarm histot•v re ort/lo to this form if available. <br />4 Each alarm for the previous month has been responded to appropriately. <br />5 Sensors located in tank -to containment sum shave not alarmed in the 01�mon_th.��I <br />5a List all tank -top sumps inhere alarms occurred in the past month: <br />A'ote: Sumps ,There all alarm furs occtared in the past month must be inspected unless a giol ted service technician responded to. and <br />properly oddressed, the cause ofthe alarm. Attach documentation t•eriif ging approprtate service to thus report. <br />Ifsum it ection is required, record results in item 6, below. <br />UST SYSTEM INSPECTION <br />6 Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located property. <br />/dote Visual ins tion o.fsum s is 01711. required in sin s where an alarm has ocnit-red in the Ust 111011th or which there is no service record. <br />Y N Y N <br />Sump Location: Sump Location: <br />Sump Location: Sump Location: <br />Sump Location: Sump Location: <br />7 Spill containment structures are free of water, debris, and hazardous substance. <br />., 1 ,., 1 1.t V N NA <br />Tank 1 — Contents.• Tank 3 — Contents: <br />Tank 2 — Contents: Tank 4 — Contents: <br />8 Under-dis enser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N NA I I Y I N I NA <br />DispensDispenser 30 / 31 <br />Dispenserr Dispenser 37 / 3.i <br />Dispenser Dispenser <br />Dispenser 27 / 2.i Dispenser <br />PAPERWORK INSPECTION Y N NA DATE DONE <br />9 Monitoring system certification has been completed within past 12 months. —/ } <br />10 Secondary containment tests have been completed within the required timeframe. <br />1 1 Spill containment structure (bucket) testing was completed within the past year. — <br />i 12 Tank tightness testing was completed within required timeframe. <br />13 Line tightness testing was completed within required timeframe. <br />14 Other required testing/maintenance was completed within required timeframe. (List test/maintenance items bel v.) <br />February 2015 monthly D.O report with incorrect secondary containment test date <br />Page 14 of 28 Photo taken on March 16, 2015 <br />