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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 />Faci4ily Name: VILLAGE WEST MARINA Date: —/ / — <br />Facility gddress: 6649 EMBARCADERO DRIVE <br />Zio Code: 95219 <br />5a <br />t Moni[onne s stern is owereo on a <br />' Monitoring system is not currently showing any alarms or wamin¢s <br />Alarm history report/109 for the previous month is available, and has been reviewed by <br />ignated UST Operator ttach a copy ojthe alarm ry historeport/log to thisform <br />h alarm for the previous (Amonth has been responded to appropriately. <br />;ors located in tank top contairiment sumps have not alarmed in the past month. <br />List all lank -top sumps ii,here alarms occurred in the past month: <br />Aote: Sm+rps ++here an alarnr has acc++rred in the parr mauh must be inspected +m less a qualified service tahninan responded to. aria <br />oroper/v addressed dta catue o%the alarm. 14110th documentation verifying appropriate service to this repon. <br />,r_...__ ..._-..,�,..� record resrdts m fie+» 6. below. <br />6 Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located prof <br />Note: 1-t—al ms ecrion olsu+u s is 01,11• re aired in sum s where m+ alarm has occurred in rhe post month or which dtere is +ro <br />Y N <br />Sunt Location: Sunt �Locatiqn:Sian Locati0, Stun <br />.Sum Location: Stun Location: <br />7 S ill containment structures are free of water, debris, and hazardous substance. <br />Y NNA <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 Vo <br />Y N NA <br />Dispenser 3, ,' Dis enser 30 / 31 <br />n: 7 i ;_ x I I I Dispenser 37 / 35 <br />Dis enser27/25 uts enser <br />PAPERWORK INSPECTION <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 />11 Spill containment structure (bucket) testing was completed within the past year. <br />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. <br />frame. <br />(_,lit- ((t i/A <br />DXTE DONE <br />ori <br />tesUtnaintenance items below <br />.)a I 13 --S=t3 <br />February 2015 monthly D.O report with correct secondary containment test date <br />Page 16 of 28 <br />N i NA <br />Photo taken on March 16, 2015 <br />