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Villa <br />e West Marina, 6649 Embarcadero Dr, Stockton, CA <br />At <br />DESIGNATED UNDERGROUND STORAGE TANK (UST) <br />- <br />OPERATOR MONTHLY VISUAL INSPECTION CHECKLIST <br />Facility Ntune: Village Nest Marina Date: <br />Facility Address: 6649 Embarcadero Drive Stocldon, CA – <br />Designated UST Operator: ) yi.'S Inspector Signature: .. <br />International Code Council Certification 4: Expire Date: V" <br />Inspector Phone: <br />F= <br />MONITORING PANEL / ALARM HISTOR <br />0<m <br />1. Monitor system is powered on and in proper operating mode: Yes _ NIA <br />2. Monitor system in "not" currently showing any alarms/warnings: Yes,/No _ N/a._ <br />3. Alarm history reporUlog for the previous month is available: Yes / No_ NIA_ <br />7_ <br />4_ 1-fistory report/log has been reviewed by designated inspector: Yes No_ N/A_ <br />5. Each alarm for the previous month has been responded to appropriately: Yes No _ NIA_ <br />• Sensors located in tank -top containment sumps have not alarmed in last month: Yes No —N/A_ <br />6a List all sensors where alarms occurred in the past month: Yes No _ NIA_ <br />NOTE: Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded <br />eport <br />to, and properly addressed, the cause of the alarm. Attach documentation verifying appropriate serv/ice to this report- <br />If <br />If sump inspection is required, record results in item 6 (below). iY/� �.� S ,../-5 Xi <br />ti. <br />UST SYSTEM INSPECTIO ��r' `/ .0" <br />h' <br />6. Tank top containment sumps are free of water, debris, and hazardous substances. Sensors arc located properly. <br />NOTE: Visual inspection of sumps is only required in sumps where an alarm )ras occurred in the past month for which dare is no service record. <br />RRiRRRRRRRR##fi##i.R#R#t#R###i.R###}#tRf#RR#RRR##RRRRRR#RR#i###*#}}#i}tt#####t#}##}#tit.}#is#i.Rtiti Rt <br />No—N/A— <br />Premium Unleaded Sump: Yes No N/A_ Diesel sump: Yes---No—N/A— <br />Manifold <br />Manifold Sump: Yes No N/A_ <br />7. Spill containment structures (ground ports) are free of water, debris, and hazardous substwices: <br />E Premium Unleaded Fill: Yes --"No N/A Vapor-. Ycs,`� No N/A <br />Diesel Fill Fill: Yes /No N/A <br />.ti . <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 i` " No <br />APERWORIC INSPECTION ' <br />9. Monitoring system certification has been completed within past 12 months: Yes /'No _ N/A —Date;Ste'' <br />I .2ndary containment tests have been completed within required time franie: Yes - No _ N1A _ Date: " 7 Z1_/Z_ <br />11. <br />/Z - <br />I1. Spill containment structure (bucket) testing completed within past year: Yes —'No — N/A _ Date: % <br />12. Tank tightness testing was completed within required time frame: Yes _ No _ N/A _ Date. <br />Yes <br />March 2014 monthly D.O report with correct secondary containment test date <br />Page 27 of 28 Photo taken on March 16, 2015 <br />