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UNDERGROUND STORAGE TANK Fosch TED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 2 of 2) MONO VII . INSPECTION HiSTORY Y N up action of section IiI from the previous inspection been completed appropriately? ❑ ntation verifying appropriate service to this report) 19 VIII . ALARM HISTORY Attach a copy of the alarm history reporVlog to this report. Y N INAl Is the monitoring system powered on and In proper operating mode? ® ❑ ❑ Has each leak detection alarm since the previous inspection been responded to appropriately? ® ❑ (Attach documentation verifying appropriate service to this report) Have all containment sumps, that have had a leak detection alarm since the previous inspection , been responded to by a qualified UST ® ❑ ❑ service technician? List below in section 1X, all containment sumps that have had a leak detection alarm since the previous inspection and have not been responded to by a qualifled UST service technician. Containment sumps listed below require a visual inspection for damage, water, debris, hazardous substance and EMeer sensor location. The results of the visual ins action must be recorded in section !X. IX. UNDERGROUND STORAGE TANK SYSTEM INSPECTION Is the containment sump free of damage, water, debris, and hazardous substance? Containment Sump ID Y N Containment Sump ID Y N T1 : Regular- STP ❑ ❑ ❑ ❑ T2 : Premium- STP ❑ ❑ ❑ ❑ T3 : Diesel- STP ❑ ❑ ❑ ❑ Are all sensors in containment sumps inspected located to detect a leak at the earliest opportunity? ❑ ❑ Is the spill container free of damage, water, debris, and hazardous substance? TANK !D T1 : Regular ® ❑ T3: Diesel ® , ❑� T2 : Premium ® ❑ ❑ Is the fill pipe free of obstructions? TANK ID T1 : Regular IgTO T3 : Diesel 101 ❑ T2 : Premium 101111 1010 Is the fill cap securely on the fill pipe? TANK ID T1 : Regular r1@1 ❑ T3 : Diesel ® ❑ T2: Premium ❑ L , —_ _� 101 ❑ Is the under-dispenser containment free of damage, water, debris , and hazardous substance? Under-dispenser Containment ID Y N NAJ Under-dispenser Containment ID Y N NA 1 /2 ® ❑ 01 O ❑ O 314 ® ❑ ❑ 11 ❑ ❑ 516 ® ❑ ❑ ❑ ❑ ❑ 7/8 ® ❑ ❑ ❑ ❑ ❑ 9/ 14 ® ❑ ❑ ❑ ❑ ❑ 11112 ® ❑ ❑ ❑ ❑ ❑ Are all sensors in under-dispenser containment located to detect a leak at the earliest opportunity? ® ❑ ❑ X. TESTING AND MAINTENANCE Y N NA DATE LAST PERFQRMED Has the monitoring system certification been completed within the past 12 months? ® ❑ 12/11 /18 Has the spill container testing been completed within the past 12 months? ® ❑ 12/1111 $ Has the overfill prevention equipment inspection been completed within the past 36 months? ® ❑ ❑ 12/11 /18 Has the secondary containment testing been completed within the past 36 months? ® ❑ ❑ 1 /24/18 /1 Has the tank tightness testing been completed within required timeframes? © ❑ ❑ Has the line tightness testing been completed within the required timeframes? ❑ ❑ ❑ Otherrequired testing / maintenance was completed within required timeframe . List testlmaintenance items below. Test / Maintenance: Air Quali test ® ❑ 12111 /18 Test / Maintenance: ❑ ❑ Test / Maintenance : ❑ ❑ Test / Maintenance: ❑ ❑ Test / Maintenance: ❑ ❑ Test / Maintenance: El ElXI. FACILITY EMPLOYEE TRAINING Y N Have all individuals performing facility employee duties received the required facility employee training within the past 12 months? ® ❑ if the facility has more components than this form accommodates, additional copies of this page may be attached Y = Yes N = No. NA = Not Aodicable. ID = IdeMirMation