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<br />nr�sigl,ntnrl 1 � � � t,
<br />L l ntirrerl„tlnrl ) tr•rnir,r 'I"'
<br />I Alirnlhl ';1i`aunlnt,h(Ii;l)(.{ � /- r'
<br />Io, II I;Irr'rkli•:1
<br />�,. , � 1'I' - I'�'� tli I.,1,. r .,a.0 Innl I'u, I , hnn I ,li I' //►
<br />I. •.l'I',:I ,. ,. I'. ttl I I ,Il it l,'il l , ll,t1, .tlilll If („ 'l lt,'11111" cn
<br />ti( Ill
<br />r1 i
<br />n. v.tw,M�,�w — MOMITORINL< PANEL / At MtFA I11'=.tUF1'/
<br />O Ali nd ,ung sysiom i powerod on and In uo i' r–
<br />Monrtonn 5 stern Is not Currentt shc>awnc July 1— I
<br />1) inns or w ,unit
<br />iAlarm history ropotL7o for the �reviaus month is c tnri has t./nurl rrtviowo<1 by ltin Un. ;ir)ngtR.t
<br />4 UST p orator. Attach a co of the, Alarm 11IStOtYCirx,,In to this ins ectton torrn. „__y
<br />Each alarm for the xevlous month has been res ended ton ro riatol 7 V,
<br />Sensorslocated 1 tank -to containment sumps have not alarmed in the est month.
<br />Lest an lank -fop sumps where alarms c>L currad in the past month:
<br />, .1';.p+ ,Ct/'•nr•S n."N'.� a^ :i'.i'm r,l� 1,:, �1 r^. •: "�i rt•i:t h• infi(h: cfrT:l IInIP15 fl gUflll/IFri sa/Ylrw fMC'rl nffr.11` I!r TJMINlgd pr, aM MrKw+NY �+7�iesawl Mn , .-.. . .
<br />1 t ', n H sumo Inspnrfion rs reduuctl, rr r ,re r..,,,rr, n •
<br />UST SYSTEM INSPECTION I
<br />Tan44op containment sumps are free of water, debris, and hazardous substance Sensors are Irra:•. t p cu" 't
<br />,
<br />`�"� , _ 'n l-'FS::ir9Q m SUT s wrrrp an afa.m nos c1-furrnA In fnP asr mJntn ICr which fnPrA rs no sur: �Ce.- rt r,rrr: - _ --_
<br />\= /Fill Sum s Y N
<br />STP Tank Sumps Y N --
<br />r,el 1
<br />Yv I 2 2
<br />3 3
<br />/r-�-F< 4 4
<br />\V 5 5
<br />QS Ii buckets (containment structures) are tree of water, debris, and hazardous substance.
<br />Fill Spill Buckets Y N NA Vapor Recover Spill Bucket Y N NA
<br />0 1 Diesel Liquid 1 Liquid pais
<br />n.bns
<br />2 Liuu,d 0pb
<br />Duhns 2 JaC,ls
<br />/}� 3 Uu-J L quid
<br />' 1 D^bus 3 Liquid
<br />`v Liquo Liquid
<br />4 Uehns
<br />Debns
<br />Llauia 5 tiquld
<br />D�b„< Debns
<br />(Q r _+_ e Under -did enser containment areas are free of water, debris, and Hazardous substance. Sensors are located erode lv
<br />(D 0
<br />N __%
<br />O
<br />O) Z7
<br />0
<br />rT-F
<br />Dispensers
<br />Y
<br />N
<br />NA
<br />Dispensers Y N N
<br />112 Llqurd
<br />UST
<br />I0brllforinL s ;leis Lcrtihc,d�pn Lura ,Ir,led
<br />11112 Liquid
<br />Gebrls
<br />Secondary containment ter•,tr, r.nrl�,wo SB -98.
<br />I
<br />Debns
<br />r'I�d.'f 1pol
<br />I,
<br />DOcun'le
<br />Fr be F 21t
<br />314 L. Id
<br />13
<br />nls
<br />Line. bnr�lrir^. , Ic'.linrl
<br />13 / i 4 U "'d
<br />Debns
<br />nr•r,c FI, �t
<br />14
<br />Other re ulred lestul(,ul;urltc+ionic' wtls corn Meted with recurred timefr
<br />rf.
<br />Genn6
<br />,; r= H. —i
<br />516
<br />Line Leak Detectors were tested%cenified
<br />0 <
<br />15116 Liquid
<br />Genes
<br />Dynamic Backpressure Ie t ST -27
<br />O
<br />Debns
<br />r"r'Y`r
<br />Static Pressure Intc' nt Pressure Decay)test ST 30
<br />lad
<br />718 Li` t"'�
<br />14e
<br />17 / 18 Duma
<br />nuhr,>
<br />2 month ream _4 Hours V
<br />lel rr„r e•,,,
<br />O
<br />Dehns
<br />I'. rt.•• r i..,,
<br />P,MN Fiat
<br />9110 — �'a°'d
<br />I?obn,
<br />19120 Liquid
<br />Debns
<br />15
<br />All facility
<br />erTlployeeS have received the required on-the-job training with
<br />A;. Float
<br />Code Timeframe Y N NA DATE
<br />ever 12 months X
<br />4 ever 36 months
<br />eve 12 months x
<br />eve 36 months
<br />ever 36 rnonfhs
<br />Line.
<br />ever 12 months
<br />ever 12 months
<br />ever 12 months
<br />every 36 monies �.
<br />every 36 months
<br />Vo Am
<br />�Nll � ^lin the past yearyear. lllred on-the-ob lfainirlon-the-job lrainin. O
<br />I n.
<br />PAPERWORK INSPECTION State
<br />9
<br />UST
<br />I0brllforinL s ;leis Lcrtihc,d�pn Lura ,Ir,led
<br />10
<br />System
<br />Secondary containment ter•,tr, r.nrl�,wo SB -98.
<br />I
<br />Testing
<br />Spill bucket (containment structure) lestmy
<br />I,
<br />DOcun'le
<br />Tank tic htrles,. leslirlc completed
<br />13
<br />nls
<br />Line. bnr�lrir^. , Ic'.linrl
<br />14
<br />Other re ulred lestul(,ul;urltc+ionic' wtls corn Meted with recurred timefr
<br />rf.
<br />14e
<br />Line Leak Detectors were tested%cenified
<br />0 <
<br />1ab
<br />VLPC r
<br />Dynamic Backpressure Ie t ST -27
<br />O
<br />14c
<br />r"r'Y`r
<br />Static Pressure Intc' nt Pressure Decay)test ST 30
<br />lad
<br />Enhanced Leak Detection (ELL)
<br />14e
<br />„r 1i
<br />Cathodic Protection
<br />2 month ream _4 Hours V
<br />lel rr„r e•,,,
<br />O
<br />/'f1
<br />_0
<br />15
<br />All facility
<br />erTlployeeS have received the required on-the-job training with
<br />v
<br />61
<br />Ail facility
<br />e.rnployc es hind within the past 30 days have received the re
<br />C7
<br />O
<br />Not • an an w r 1 •'N” h rl x vain • n t nn nt n below. will r ulr I II
<br />0
<br />Q
<br />�7
<br />��Ur111 flr�rltb
<br />CD
<br />Follow u
<br />N
<br />O
<br />A
<br />Code Timeframe Y N NA DATE
<br />ever 12 months X
<br />4 ever 36 months
<br />eve 12 months x
<br />eve 36 months
<br />ever 36 rnonfhs
<br />Line.
<br />ever 12 months
<br />ever 12 months
<br />ever 12 months
<br />every 36 monies �.
<br />every 36 months
<br />Vo Am
<br />�Nll � ^lin the past yearyear. lllred on-the-ob lfainirlon-the-job lrainin. O
<br />I n.
<br />
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