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tJNDEttG tOUND-STCtRAt311 MIK FHas4oach E f D; UNDI t GRQ11Nl 3 Q C!<s TANK IDPIE.WV �FISUAL 1�l$PEC�TIQN. PERT: zotz 1i'11: . IN$ !EGTIQN: 111? RY follow-up action of Section iil .frorn the previous .inspection been completed eppropriatety? Y . FItach docufrrentetkin. verilying io service la this re ort. 1 . 101CD a►111. AVtRM FIISTQRY . : Adttah a of the 818ft histaty Mft to this rVart, Y N NA Moths mankedng ,systern powered on and in proper operatIng mode? SI ❑ ❑ Has each leak detection alarm since the previous- inspection been responded to appropriately? Im ❑ ❑ AMmh deMmoftflon yoftl1w wrWisto service to this report. Have all wntainnwnt sumps that have had a leak detection alarm since .the previous inspection been responded to by a ® ❑ ❑ ualifled UST Service Technician?. Lldtbefow In Section IN all 4ontahsmaM sumps that have had a look detection &Ianrn since the previous inspection and have not been Am pandad to bya quallNad usl samice Technician. Containment sumps listed below require a visual Inspection for dams", water, deb^ haurdous substance and Pmxr senses locat/on. The results of the ftMI 1 ion must be recorded /n Section 1X iX. . UNDERGROUND $iQRAGE TANIt SY3TSM: INSPECTION, is the containment sump free of damage, water, debris, and hazardous substance? Containment Sum ID Y; . .N. Containment .Sum 11) Y:.: : N . n [31 ❑ ❑. ❑ 13 ❑ ❑ ❑ 01 Q. Ane. all sensors in containment sump* inspected located to detect a leek at the earliest opportunity? ( N / A ) Is the soil container-fte .of dam. e, water, deb" and hazardous subslanet37 TOM . P " . uc et-8 IN 1 . ❑ 1 Tank ID I Spilluc a ese ❑ Tank 1D I Spill Bucket-91 ® 1131 Tank: 10 14 ❑ . O Is.the flll i free bf dbstnictions? Tank 10 Spill BUCKSInal ® ❑ TanklD 155111 buckst=UISSOI Tank ID Spill Bucket-91 IID ❑ Tank ID 1s the fill . cap secure) . on the ;I'l pipe? Tank 10 Spill Buc etwU ® 10 1 Tank ll Bucket 1es`e got. d I . Tank lD. ISPIUSUC at M 13Tank ID 11 Cl is the qndermclisponeer containment free of dams a, caster debris," and hazardous eutistance? Under-Dia unser Containment 10 :. Y . .N NAI urldem)lspahso Containment. ID Y: : N N'. . DispensermIN ❑ 01 ❑ ❑ ❑ spenser QQ ❑ ❑ G CJ CI Dispenser=5l6 ® ❑ ❑ ©. ❑ .Q ul = I fo ❑ ❑ ❑ CI ❑ ❑ ❑ ❑ ❑ . ❑ ❑ ❑ ❑ ❑ 01010 Are all sensors in under4apen8+rcoM6inment located to detect .a leak at Utie earliest opportunity? jai 131 ❑ X. . TI STING AND. MAIINTI NANC9 1F : : , N . NA p oto fined Has the monitoring system certification "been completed within the past 12 months? 10 ❑ 05/2212019 Has the:sill :contaiinertestingbeenoompleted. withinthe. paat12months? ® ❑ 45 $W2005 / 22 / 2019 Has-the a+(erfill prevention -equipment inspection been oompieted within the`past 36 months? ® ❑ ❑ 05/06/2019 Has the. sewnday eontoinment testing been completed WOMAN past 36. months? ❑ ❑ 01 /03/2017 Has the.tank tightness testing been completed within required tirneframes? ❑ IQ Ia N/A Has thsliho ti fitness t$sting been completed within the required timeframes? Q ❑ ® N/A tither requirttd testing ! maintenance v+/ss completed. v*hln requiredtimefre me. (Ust testlmalntehance Items below)_ FF Test I Maintenance: ❑ ❑ Test / Maintenance: ❑ ❑ Test / Maintenance: © ❑ ,y Teat/ Maintenance: ❑ ❑ Too IMaintenance: t7 ❑ Test ! Maintenance: CI ❑' XI: FltlCtLtTY :'EMI'4OY ETRAiNINQ it N Hava :ali Individuals performing facility employso duties received the tepuired -faellity .employee. training within the. batt 12 months? 111111 13 Itha runty has more m mponsnts than this form sccoormodatss, addltlonal.cophrs. of this ~ May be 4tisah04 IF Y e Y0k.N a No, Nil a NotAppNgbW, ID = Mmtfication TESORO = 68153 - 01 /10/2020