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Village West Marina, 6649 Embarcadero Dr, Stockton, CA <br />Designated Underground Storage T <br />Monthly Visual Inspectio <br />natcd O for Conducting the Inspection: GREG KAISER <br />national Code. nctl yTrurication h: 5252318 <br />aturc: w <br />Item MONITORING PANEL / ALARM I <br />I Monitoring s stem is owered on and in ro er o eratin mode. <br />2 Monitoring system is not currentl show", an alarms or warnin s. <br />3 Alarm history report/log for the previous month is available, and has t <br />Desi nate' UST erator. Attach a co o the alarm histo report <br />4 Each alarm for the previous month has been responded to _appropriate <br />5 Sensors located in tank -to containment sumps have not alarmed in tl <br />5a - List all tank -top sumps where alarms occurred in the past month. <br />A'ote: Sumps where an alarm has occurred m the past month mus(be inspected tc <br />properly addressed the Douse ojlhe alarm. Attach documentation verifying apps <br />! sum Inspect rs re fired record results in item 6, below. <br />UST SYSTEM INSPECTI( <br />i 6 Tank -top containment sumps are free of water, debris, and hazardous <br />Note Visual inspection o sum s is onty required in sumps where an alarm has oca <br />Y N <br />Sum Location: Sump Lo! <br />Sump Location: Sump Lot <br />Sump Location: Sump Lot <br />7 Spill containment structures are free of water, debris, and hazardous <br />Y N NA <br />Tank 1 —Contents: X Tank 3 — <br />Tank 2 — Contents: X Tank 4 — <br />8 Under -dispenser containment areas are free of water, debris, and haz <br />Y I N NA <br />27125 <br />(UST) Operator <br />.iecklist <br />ition Date: IS - <br />209 887-2639 <br />Y=Yes,N= No, NA=Not A li able <br />I.STORY I Y I N I NA <br />X <br />een reviewed by the <br />tog to this orm i available.) <br />te <br />Y. X <br />e past month. Y <br />less a qualified service technician responded to. and <br />riate service to this report. <br />ubstance. Sensors are located properly. <br />d in the past month ror which there is no service record <br />Y N <br />tion: <br />tion: <br />tion: <br />bstance. <br />Y I N I NA <br />dous substance. Sensors are <br />30/31 <br />37135 <br />PAPERWORK INSPECTION Y N NA DATE. DON <br />9 Monitoring system certification has been completed within past 12 m nths. _ —/ 3 <br />10 Secondary containment tests have been completed within the requirec requiretiinefi-ame. 3 — —� <br />11 S ill containment structure (bucket) testing was completed within the past year. <br />12 Tank tigbtness testing was completed within required timeframe. <br />13 Line tightness testing was completed within required timeframe. <br />IA ll.l.e� _ _____ . . . _ A_ <br />October 2014 monthly D.O report with correct secondary containment test date <br />Page 20 of 28 Photo taken on March 16, 2015 <br />