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Village West Marina, 6649 Embarcadero Dr, Stockton, CA <br />Designated Underground Storage Tank (UST) Operator = y <br />Monthly Visual Inspection Checklist <br />Facilirs, Name: VILLAGE WEST MARINA <br />i Facilin Address: 6649 EMBARCADERO DRIVE <br />i t its STOCKTON Zip Code: 95219 <br />Dcsi,nated UST V erator Conducting the Inspection. GREG KAISER <br />International Code Cowncil Certification #: 5252318 Expiration Date: 10/152015 <br />Signature — Phone: ( 209 ) 887-2639 1 <br />�+ l = Yes, N No, NA Vot A likable <br />RM HISTORY Y N tia <br />PAPERWORK INSPECTION Y N NA DATE DONE <br />9 Monitorin s stem certification has been tom leted within ast 12 months. ^' '-� <br />10 Seconds containment tests have been tom leted within the re uired timeframe. ' - --I �- <br />1 1 Sill containment structure (bucket testin was tom leted within the ast earl --i — <br />12 Tank tietltness testin>; was completed within required timeframe. <br />November 2014 monthly D.O report with correct secondary containment test date <br />Page 19 of 28 Photo taken on March 16, 2015 <br />t item MONITORING PANEL / ALA <br />1 Monitoring system is powered on and in proper operating mode. <br />2 1 Nfonitorin<_� system is not currentl showin any alarms or warnings. <br />Alarm history report/log for the previous month is available, and has been reviewed by the <br />Designated UST Operator. (Attach a copy of the alarm histolre ort/lo to this form if available.) y <br />4 Each alarm for the previous month has been responded to appropriately. <br />5 Sensors located in tank -to containment sumps have not alarmed in the past month. Y <br />5a _ List all tank -top sumps nvhere alarms occurred in the past month: <br />t <br />Mate: Sumps inhere un alarni has occurred in the past month rust be inspected unless a qualified service technician responded to, and <br />properhv addressed, dee cause of the alarm. Attach documentation verifying appropriate service to this report. <br />t sten inspection is required. record results in item 6, below. <br />UST SYSTEM INSPECTION <br />Lj k -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />ote: h sual ins ection o scan s is onl y re uired in stmt s where an alarm has occurred in die ast month or which !here is no service retard. <br />Z,N <br />Location: Sum Location: <br />Location: Sum Location: <br />Location: Sum Location: <br />7 S ill containment structures are free of water, debris, and hazardous substance, <br />Y N NA Y N NA <br />Tank 1 —Contents: Tank 3 — Contents: <br />Tank 2 — Contents: ,L Tank 4 — Contents: <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located to eel <br />Y N NA <br />Y NRDivripayet- <br />Dispenser s enser 30 / 3 / <br />Dispenser- �5 37 / 35 <br />Dis enser 2321 3 >`spenser <br />Dispenser27/25 Dispenser <br />PAPERWORK INSPECTION Y N NA DATE DONE <br />9 Monitorin s stem certification has been tom leted within ast 12 months. ^' '-� <br />10 Seconds containment tests have been tom leted within the re uired timeframe. ' - --I �- <br />1 1 Sill containment structure (bucket testin was tom leted within the ast earl --i — <br />12 Tank tietltness testin>; was completed within required timeframe. <br />November 2014 monthly D.O report with correct secondary containment test date <br />Page 19 of 28 Photo taken on March 16, 2015 <br />