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Village <br />West Marina, 6649 Embarcadero Dr, <br />VIIAI <br />_-- "tTesi nated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />VILLAGE WEST MARINA I Date: / _ / . S` <br />+ <br />Wdreti : 6649 EMBARCADERO DRIVE <br />_ STOCKTON Zip Code- 95219 <br />Asi zndted UST tV emtor Conducting the inspection: GREG KAISER <br />temational Code Council Cert t Yon / 5252318 <br />Expiration Date: 10115/201-,, <br />Signature: !I <br />Phone:( 209 )887-2639 <br />i <br />item MONITORING PANEL I ALARM HISTORY <br />Monitoring system is powered on and in proper operating mode, i k <br />�tonnonng system is not currentl% shoe mg any alarms or warnings. <br />Alarm history report, log for the previous month is available, and has been reviewed by the <br />X <br />_ Designated UST Operator. (Attach a copy ojthe alarm history repot-WoQ to this forin tjm ailable ) <br />4 Each alarm for the preN sous month has been responded to a ro nate! I X <br />8 <br />3 <br />sensors located in rank -to containment sumps have not alarmed in the est month. <br />j <br />List all tank -top stamps where alai -ins occurr din rhe past mon n: Q ' L 3 C <br />CA+�i k�IL2 c C �i Aa t� L <br />� � <br />I �'ou: Sumps where an alarm has crcttrrtd to the past month lust be nupected unless a quuh d service 4•c i <br />proprryoddressed rhe casae oJrhe alurm. anach donunentanat rerjvh+ +g�>�e � <br />Stockton, CA <br />is - — I 1%sxmtp nspecuon is required record resxrhs in uem 6r b loi 3 i—ropnate sent to tilts <br />� t�� GGGIII <br />UST SYSTEM INSPECTION <br />6 Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properh. <br />�� 1bre tis:.al mspectron o%srunps is only mqutrd ai sumps inhere ori alarm has occirred to the post month jot which there is no se—ce record. <br />I Sum Locanan: SuTp Location: <br />Sum Location: I Stun Location: <br />I <br />Sunp Location: S11n!p Location: <br />7 ! Spill containment structures are free of water, debris and hazardous substance. <br />Tank I -Contents: Tank 3 -Contents: <br />Tank ? - Contents: t, Tank 43 Contents <br />S L nder dispenser containment areas are free of water debris and hazardous substance. Sensors are <br />-1,�7 <br />is enser 30 % 31 <br />D1 Dis eliser 3?.' 3j <br />D�I > Dispenser <br />Dispenj r <br />PAPERWORK INSPECTION Y N Na DATE DONE <br />9 9fonitorina s stem cenitication has been com leted within ast 12 months. _ <br />10 Seconda .' containment tests have been completed within the re uired timehame. )z 1 <br />11 S ill containment structure (bucket) testin was com leted within the ast ear. <br />1= Tank tightness testingY <br />was com leted within required timeframe. <br />13 i Line ti htness testing was com leted within required timeframe. <br />la Other required testin maintenance was completed within required timeframe. List tesUntuintenunce items below.) <br />Test'.Vaitltenance. <br />January 2015 monthly D.O report with correct secondary containment test date. Also the C2 Diesel <br />Annular Space Sensor Out Alarm/ Fuel Alarm is documented <br />Page 17 of 28 Photo taken on March 16, 2015 <br />