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2020 - 02 - 19 080" 21 Diesel 223 2095993680 > > Loves P 2/4 UNDERGROUND SCOWETANK DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Pago 2 of 2) ViI. INSPECTION HISTORY Has each follow-up action of Section q1 from the previous inspection been completed appropriately? Y N Attach documantatlonygrif yLng ap ru date service to this reports (� VUI. ALARM HISTORY Attach a copy of the alarm history reportflog to this re art. Y N INA Is the monitoring system Rowered on and in proper operating mode? YM C3 13 Has each leak detection alarm since the previous inspection been responded to appropriately? In ❑ ❑ Attach documantatlon yRr1WnffftPproPjj8tQ service to this t'e ort, Have all containment Sumps that have had a leak detection alarm since the previous inspection been responded to by a ❑ 13ualified UST Service Technician? List below in Sectlon IX aA containment sumps that have had a leak detection alarm since the previous Inspection end have not been responded to bye qualified UST Service Technician. Containment sumps listed below requires visual Inspection for damage, water, debris, hazardous substance and proper sensor location. The results of the Visual Ina ction most be recorded in Section IX IX- UNDERGROUND STORAGE TANK SYSTEM INSPECTION F .Is the containment sum I j2 free of damage, water, debris, and hazardous substance? ContainmontSum ID Y N Containment Sume ID Y N 1313 ❑ 13 1313 1313 ❑ a 13 13 13 13 n 0 Ate all sensors in containment sumps inspected located to detect a leak at the earliest opportunity? [31 ❑ Is the spill container free of damage, water, debris, and hazardous substance? Tank IDI ilrVCrC" tdt"-$7"E:T k , 19 1 ❑ I Tank ID I tipillUo a ase a ❑ Tank ID I WillUG e - R9 O 'Tank iD I *pill ESUCKOMIOSOIW05Q Is the {ill pipe ['ems of .$ ERS" t Wrest Spill-t3 {(�Ylyt Tank 10 [� Tank IDQ Tank lDip u [ Tank ID Rt uc e - tese es X) ❑ Is the till cap secureIX on the fill pipe? Tank ID UP111 LSUCKOV01CaST, Of VV6151 [31 Tank ID I bPfllttC 6 - eS9 8S ❑ Tank ID Q Tank 11) 569 XI ❑ Is the under-dls enser containment free of dams e, water, debris, and hazardous substance? Under-Cris neer Containment ID Y N NA Under-�t is r Containment ID Y N N IspettserAV A ® 13 ❑ Disperiser-23 420 4l 5 E1:1 ❑ er;:=, '77 ❑ 13t 13 ❑ Dlsanser=9110, 11 /12 99 13 Q 13 C3 1:11 Ispensar='13f14;t4j(1 ® ❑ ❑ ❑ © ❑ - ® 1313 1313 ❑ Tspenser- 13 ❑ a ❑ Are all sensors In untter.disponser contalaynent looted to detain a leak at the earliest opportunity? X. TESTING AND MAINTENANCE Y N NA Date Last Performed Has the monitoring system certification been completed within the past 12 months? ❑ 8/6119 Has the $pill container testing been completed within the past 12 months? ❑ Has the overfill prevention equipment inspection beers completed within theest 36 months? 29 ❑ ❑ Has the seconday containment testing been completed within the past 36 months? Mill ❑ Has the tank tightness testing been completed within required timeframes? ❑ ❑ Has the line tightness testing been completed within the required timeframes? ❑ ❑ e16/7g Cather required testing 1 maintenance was completed within required timeframe. (List tastImaintenance Items beta Test / Maintenance: ❑ I ❑ Test / Maintenance: Toat/Maintenance: O 13 Test / Maintenance: Test/Maintenance: O Test / Maintenance: T , ,estiMaintgrigrice © ❑ Test / Maintenance: TestiMaintenanca: ❑ 1 1 Test i Maintenance: 13 C31 I XL FACILITY EMPLOYEE TRAINING Y N Have all individuel5 performing facility employee dudes received the required facility employee training within the past 12 months? ❑ 1 the tactlity has more components than this fort accommodates, additional copies of this page may be allached. Y = Yos, N u No, NA n Piot Applicoblo, ip a identification 1,0VIi8 - 223 - 1 ^.12812019