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im <br />e West Marina, 6649 Embarcadero Dr, Stockton, CA <br />Q Storage Designated Underground Storabe Tank (UST) ) Operator <br />Monthly Visual Inspection Checklist <br />Fy •ilia Name VILLAGE WEST MARINA Date: 1 –1 – lyt <br />Facility Address: 6649 EMBARCADERO DRIVE <br />llf\': JI VVAIVn - - <br />Desi�nat ti LIST Operator Conductin the Inspection: GREG KAISER <br />Intemational Codc Coduarl Ce lification #: 5252318 Ea iration Date: 10/15/2015 <br />�i nature' ire –�� Phone: ( 209 ) 887.2639 <br />Y=Yes,N= <br />Item MONITORING PANEL / ALARM HISTORY <br />I Atonitoring system is powered on and in proper operating mode. <br />Monitoring system is not currently showing any alarms or warnings. <br />3 .alarm history reporttlog for the previous month is available, and has been reviewed by the <br />Designated UST Operator. (Attach a copy o%7he alarm history reporNog to thisform ifavailable <br />a 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 />5a List all tank -top sumps where alarms occurred in the past month: <br />X <br />Able: Sumps where an alarm lras occurred in rhe past mach must be inspected rayless a qualified service technician responded to, and <br />properly addressed the cause ofthe alarm. dually documentation verifving appropriate service to this report. <br />—� tf sump inspecuon is required. record results in item 6. below. <br />UST SYSTEM INSPECTION <br />ant: -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />ive. Visual inspection ofsumps is only required in sumps where an alarm has occurred in the past month for which there is no service record. <br />Sump Location.- Sum Location: <br />Sump Location: Sump Location: <br />Sum Location: Sump Location: <br />7 j Spill containment structures are free ofwater, debris, and hazardous substai <br />1 Tank I - Contents: 1 Tank 3 - Contents: <br />Tank -2 - Contents: Y I Tank 4 Contents: <br />S Cinder-dis enser containment areas are free of water, debris, and hazardous substance. Sensors are located <br />Y N NA y <br />Dis erne �3T1- j !_ \ Dis enser 30 / 31 <br />Dr"s enser�-�- 7 1V i_ �• __ Dispenser 37 / 35 <br />27/ZS <br />PAPERWORK INSPECTION Y N NA <br />9 Monitorin s stem certification has been coin feted within ast 12 months. <br />10 Second containment tests have been com feted within the r uired timeframe. <br />11 S ill containment structure (bucket) testin was coin feted within the ast ear. )c <br />12 Tank ti tress testin was com feted within re uired timeframe. <br />13 Line ti tress testin was com feted within re uired timeframe. <br />14 Other r uired testis maintenance was com feted within re uired timefram <br />Tes11,V ' <br />July 2014 monthly D.O report with correct secondary containment test date <br />TE <br />NA <br />Page 23 of 28 Photo taken on March 16, 2015 <br />