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Village West Marina, 6649 Embarcadero Dr, Stockton, CA <br />ir Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />4 t a�iti Name, vu t F e!`WEST MARINA Date: <br />Facilit , Address: 6649 EMBARCADERO DRIVE <br />crnr ilrnN Zip Code: 95219 <br />Desienated UST O erator Conductin the Inspection: GREG KAIStK <br />International Code n -'1 Verrification #: 5252318 Ex iration Date: 10/152015 <br />Si4maatre: <br />Phone:( 209 ) 887-2639 <br />Y = Ya, N = No, NA = Not Aoulicabk <br />3 <br />5a <br />MONITORING PANEL / ALARM HISTORY <br />bfonitorin system is powered on and in proper o eratin mode. <br />Monitoring system is not currently showing any alarms or warnings. <br />Alarm history repor-t/log for the previous month is available, and has been reviewed by the <br />Designated UST Operator. (Attach a copy ofthe alarm history report/log to this form if availab <br />Each alarm for the previous month has been responded to appropriately. <br />Sensors located in tank -top containment sumps have not alarmed in the past month. <br />- List all tank -top sumps where alai -ins occurred in the past month: <br />k <br />{ Note., Sumps where analarm has occurred in the past month must be inspected unless a qualified service technician responded to. and <br />properly addressed, the cause ofrhe alarm. Attach documentation verifying appropriate service to this report. <br />l(sum rn ection is required record results in item 6, below. <br />UST SYSTEM INSPECTION <br />7Tank-to�p containmentsumps are free ofwater, debris, and hazardous substance. Sensors are located properly. <br />ore: 1 sual uu ection o sum s is onl re uired in sum s where an alarm has occurred in the ast month or which there is no serviceect <br />Y N <br />r Location:Sum Location: <br />Location: Sum Location: <br />Location: Sum Location: <br />7 Spill containment structures are free of water, debris, and hazardous substance. y N <br />Y N INA <br />Tank I —Contents., DYI Tank 3 —Contents: <br />Tank 2 — Contents: Tank 4 — Contents: <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are locatTV ed r N rl r <br />Y 1 N NA <br />27/25 <br />30/31 <br />37/35 <br />PAPERWORK INSPECTION Y N NA DATE D( <br />012TAnk <br />onitorin s stem certification has been completed within past 12 months. --� <br />cond containment tests have been completed within therequired timeframe. _ <br />ll containment structure bucket testingwas com leted within the past ear. 1G <br />tightness tine was completed within re uired timeframe. <br />September 2014 monthly D.O report with correct secondary containment test date <br />Page 21 of 28 Photo taken on March 16, 2015 <br />