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UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT(Page 2 of 2 <br /> VII. INSPECTION HISTORY Y N <br /> Has each follow-up action of section III from the previous inspection been completed appropriately? X <br /> Attach documentation verifying appropriate service to this report.) <br /> VIII.ALARM HISTORY <br /> Attach a copy of the alarm history reportilogto this report. <br /> Is the monitoring system powered on and in proper operating mode? X <br /> Has each leak detection alarm since the previous inspection been responded to appropriately? <br /> (Attach documentation verifvino aoorooriate service to this reoort.) X <br /> Have all containment sumps,that have had a leak detection alarm since the previous inspection,been responded to by a X <br /> qualified UST service technician? <br /> List below in section IX,all containment sumps that have had a leak detection alarm since the previous inspection and have not been responded to <br /> by a qualified UST service technician.Containment sumps listed below require a visual inspection for damage,water,debris,hazardous substance, <br /> and proper sensor location.The results of the visual inspection must be recorded in section IX. <br /> IX. UNDERGROUND STORAGE TANK SYSTEM INSPECTION <br /> Is the containment sump free of damage,water,debris,and hazardous substance? <br /> Containment Sump ID Y N Containment Sump ID Y N <br /> N/A X N/A X <br /> N/A X NIA X <br /> N/A X <br /> N/A X <br /> Are all sensors in containment sumps inspected located to detect a leak at the earliest opportunity? EX N �} <br /> Is the spill container free of damage,water,debris and hazardous substance? <br /> M1 <br /> TANK ID Tank-87 X <br /> Tank-91 X <br /> Is the fill pipe free of obstructions? <br /> Tank-87 X <br /> TANK ID Tank-91 X <br /> Is the fill cap securely on the fill pipe? <br /> Tank-87 X <br /> TANK ID Tank-91 X <br /> Is the under-diso ns r containment free of damage water.debris.and hazardous substance? <br /> Under-dispenser Containment ID Y N I N/A Under-dispenser Containment ID Y N N/A <br /> Dispenser-112 X <br /> Dispenser-314 X <br /> Are all sensors in under-dispenser containment located to detect a leak at the earliest opportunity? X MR <br /> X. TESTING AND MAINTENANCE Y N N/A DATE LAST /31/ <br /> PERFORMED <br /> Has the monitoring system certification been completed within the past 12 months? X 9/28/18 <br /> Has the spill container testing been completed within the past 12 months? X 9/28/18 <br /> Has the overfill prevention equipment inspection been completed within the past 36 months? X <br /> Has the secondary containment testing been completed within the past 36 months? X 9/5118 <br /> Has the tank tightness testing been completed within required timeframes? x NIA <br /> Has the line tightness testing been completed within the required timeframes? X N/A <br /> Other required testing/maintenance was completed within required timeframe.(List test/maintenance items below.) <br /> Test/Maintenance: X N/A <br /> Test/Maintenance: X N/A <br /> Test/Maintenance: X N/A <br /> Test/Maintenance: X N/A <br /> Test/Maintenance: X <br /> XI. FACILITY EMPLOYEE TRAINING Y N <br /> Have all individuals performing facility employee duties received the required facility employee training within the past 12 months? X <br />