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Village West Marina, 6649 Embarcadero Dr, Stockton, CA <br />Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />I 1- . _ ,-;Z _tCl <br />I.i.ilin �;unr: VILLAGE WEST MARINA _ <br />I a.ilit� :\ddrcss: 6649 EMBARCADERO DRIVE <br />STOCKTON <br />Designated UST O crat r Co ducting the Ins ecti <br />International Code ('G& -1 ertilication f': 525231 <br />Sicnauire l/I <br />Zip Code: 95119 <br />KAISER <br />Expiration Date: 10/15/201_5_ <br />Phone:( 209 ) 887.2639 <br />Y=Y'es.`=\o.�A= <br />TIT. I / MONITORING PANEL/ ALARM HIN I UKr <br />I onitoringg system is powered on and in proper operating mode. <br />Nlonitoring sN'stein is not currently showing any alarms or warn in s. <br />3 Alamt history reporulog for the previous month is available, and has been reviewed by the <br />Designated UST Operator. (Attach a copy of the alarm history report/log to this form if ai <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 />`a List all tank -top sumps where alarms occurred in the past month; <br />.,re: Smnps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to. and <br />properh• addressed. the cause of the alarm. Attach documentation verifying appropriate service to this report. <br />Il sump inspection is required record results in item 6 belmv. <br />UST SYSTEM INSPECTION <br />5 Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />I F ,%ore. Visual inspection ofsumps is onlv required in sumps where an alarm has occurred in the past month for which there is no service <br />o Y <br />Sump Location: <br />Sump Location: <br />Sum Location: <br />7 1 Spill containment structures are free of water, <br />Tank 1 — Contents: <br />Tank 2 — Contents: <br />8 Under -dispenser containment areas are free of water. <br />Dis ensel=-3! - U <br />Dis enser-rte <br />Dispenser ; <br />Dispenser 27 / 25 <br />Sum Location: <br />Sum Location: <br />Sump Location: <br />and hazardous substance. <br />NA <br />Tank 3 — Contents: <br />Tank 4 — Contents: <br />and hazardous substance. Sensors are located <br />30/31 <br />37/35 <br />PAPERWORK INSPECTION I Y I N INAI DATE DONT <br />9 1 Monitorin system certification has been completed within past 12 months. t y <br />10 Secondary containment tests have been completed within the required timeframe. \. ^ y - j <br />611h 1 N Spill containment structure (bucket) testing was completed within the past year. <br />12 1 Tank tightness testing was completed within required timeframe. <br />13 1 Line tightness testing was completed within required timeframe. <br />14 1 Other required testing/maintenance was completed within required timeframe. (List tesdmaintenance items helaw. l <br />June 2014 monthly D.O report with correct secondary containment test date <br />Page 24 of 28 Photo taken on March 16, 2015 <br />