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West Marina, 6649 Embarcadero Dr, <br />DESIGNATEU UNULKUt-<UUIJu J l UrCHht I ANK (U5T-) <br />OPERATOR MONTHLY VISUAL INSPECTION CHECKLIST <br />Parilil\;nu \ ill;l c West Marina Date: <br />ct(,41/ Fntbarcadero Drive Stockton, CA 15_ <br />Trg <br />April 2014 monthly <br />Stockton, <br />MIN".' <br />llcsignated USI' Operator: ., s Tries inspector Signature: <br />International Code Council Certification #: -'1G3S6 r Expire Date: <br />Inspector Phone: O'S jr-f73 G <br />MONITORING PANEL / ALARM HISTOR ' <br />1. Monitor sv stem is poNN cred on and in proper operating mode: Yes'No N/A_ <br />2. Monitor sy stem in "not currently showing any alarms/warthings: Yes 1 No_ N/A_ <br />Alann history report/log for the previous month is available: Yes i�No NIA_ <br />4. History reportJlog has been reviewed by designated inspector: Yes — No_ NrA <br />5. Each alarm for the previous month has been responded to appropriately: Yes_ No_ N/A r— <br />• Sensors located in tank -top containment sumps have not alarmed in last month: Yes _ No_ N/A r <br />5a List all sensors where alarms occurred in the past month: Yes _ No N/A <br />NOTE: Sumps where an alum has occurred in (fie past month must be inspected unless a qualified service technician responded <br />to, and properly addressed, the cause of the alarm. Attach documentation verifying appropriate service to this report- <br />lfsump inspection is required, record results in item 6 (below). <br />ST SYSTEM INSPECTIO <br />6. Tank top containment sumps are flee of water, debris, and hazardous substances. Sensors etre located properly. <br />NOTE: Visual inspection orsumps is only required in sumps where an alarm has occurred in the past month for which there is no service record. <br />istt<R..R<t<i itii<Ri♦RttRitti RlRi FR<R}tilt R<!■Rtttttrttrt trRtiitif t}shit;a Riititt►tit to R.<tt Rtt ittlttttit <br />Premium Unleaded Sump: Yes --17o _ N/A _ Diesel sump: Yes f'No _ N!A _ <br />Manifold Sump: Yes "No_ N/A_ <br /><ttrtit sills♦itiiitiitiiittititiiat#itiftiltr Rat#matt#iii Rttit#t#ilii#iitiaai;t titiitiiiattittattttita <br />7. Spill containment structures (groinports) are free of water, debris, and hazardous substances: <br />Premium Unleaded Fill: Yes_ No_ N/A_ Vapor: Yes No N/A <br />Diesel Fill Fill: Yes No <br />N/A_ _ <br />st•tie*tsirisrsisis#wtsisrtlrirswr#siiisrtatsisssiasaassssiatt#stiittstiss•iastitsastaaat►i#ssatttasti <br />S. Under -Dispenser containment areas are free of water, debris, and hazardous substances. Sensors are located properly. <br />Dispenser 1 Premium: Yes No <br />Dispenser 2 Premium: Yes No <br />Dispenser 3 Diesel: Yes '-- No <br />PAPERWORK INSPECTION <br />Monitoring system certification has been completed within past 12 months: Yes ,"No _ N/A _ Date: " /t <br />�. 2ndary containment tests have been completed within required time liame: Yes % No _N/A _Date: I L <br />Spill containment structure (bucket) testing completed within past year: Yes L No _ N/A _ Date: <br />Tank tightness testing was completed within required time frame: Yes_ No_ NIA _Date: _ <br />Line tightness testing was completed within required time hame: Yes— No _ N/A_ <br />—�— <br />D.O report with correct secondary containment test date <br />Page 26 of 28 <br />C� <br />Photo taken on March 16, 2015 <br />