COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

Jun 02 20 , 03 : 03p p . 10 77 IF UNDERGROUND STORAGE TANKIF - . - : QESICA7ED UP1DE$GROIJ [�iR. $ OR�k�aE TAPIItJpRATflR , 1(1SUAt _IN.ripECTION-REP CdRT.�Paye 2ofi' r . . . IF I _ . =:Vi1 INSi°CTION HI$TO} Y , IF Has each follow up action of Section ill From the previous inspection been completed appropriately? Y N: Attach documentation veIF I L ' n a rodatesere/ce to this reportIF I [� ❑ FF IF IF FV I' L ,VIII . , iALARM H!SOFiY . - IFF 7, Roach a cop of the alarm history report/log to this report, Is the monitorin system powered on and in proper operating mode? p1 Q 1 ❑ Has each leak detection alarm since the previous inspection been responded to appropriately? ❑ ❑ Attach documentation in a ro riate service to this Mort Have all containment sumps that have had a leak detection alarm since the previous inspection been responded to by a [3 ❑ .qualified UST Service Technician? ox List below in Section JX all containment sumps that have had a leak detection alarm since the previous inspection and have not been PF responded to bya qualified UST Service Technician. Containment sumps listed below require a visual inspection fordamage, water, debris, hazardous substance, anderg ersensor location. The results of the visual Inspection mustbe recordedin Section iX IF F _ . F, I IFiX. UNDERGROUNp IIISTORAGE TANI{'-SYSTEM: IN�a�E IOTt . . Is the containment sump free of damage, water, debris, and hazardous substance? Containment Sump ID Containment Sump ID : Y _:N ❑ ! ❑ ❑ ❑ . 111 ❑ I ❑ Are all sensors in containment sumps inspected located to detect a leak at the earliest opportunity?RR IF I ❑ Is the spill container free of dama e, water, debris, and hazardous substance? Tank ID 87 F [x] ❑ 1 Tank ID ' Tank ID 191 1 PPI El ❑ Tankid Is the fill pipe free of obstructions? Tank ID 187 p ❑ Tank ID DSL p ' ❑ TanklD Igi Q I ❑ I Tank ID I ❑ ❑ 1 Is the fill cap securely on the fill pipe? ^.-. TanklD 87 Q ❑ Tank 1D DSL 1 p ❑ TankID 91 1 M I ❑ TanklD ❑ ❑ Is the under-dispenser containment free of dam e, water, debris , and hazardous substance ? llnder-Dis enser Containment ID Y ` N : NA Under-Dispenser Containment ID ` :Y ' : M1I :' Dispenser 1 /2 CJ0 1 ❑ 1 Dispenser 314 19 ❑ ❑ Dispenser 816 © 1 ❑ ❑ Dispenser 7/8 p ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Cl ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Are all sensors in under-dispenser containment located to detect a leak at the earliest opportunity? ❑ ❑ Cl : .FIF ,, . . . . ' FLIF IF I - I IF II IFXOWN . IF . TESTING AND MAIiNTENAh10E _ Y N ; NA Date fast IF erforrried Has the monitoring system certification been completed within the past 12 months? fl ❑ r'a> 4/812019 Has the spill container testing been completed within the past 12 months? (B ❑ gill ! 4/8/2019 Has the overi'71 prevention equipment inspection been completed within the past 36 months? ® El El9/2412018 Has the secondary containment testing been completed within the past 36 months? ❑ ❑ 8/23/2017 Has the tank tightness testing been completed within required timeframes? Ell ❑ p Has the line tightness testing been completed within the required timeframes? Ell ❑ p Other required testing / maintenance was completed within required timeframe. (List fest/maintenarice items below. IF Test / Maintenance: ❑ ❑ :i " f Test 1 Maintenance* ❑ ❑ Test / Maintenance: 0 ❑ Test / Maintenance: ❑ ❑ =i`` Testi Maintenance: ❑ © �'��x.�`.; ,---. Test / Maintenance: � IF Xh FACILITY EmPt_UYEE TI IAINING _:. : Y : - ,N . Have all individuals performing facility employee duties received the required facility employee training within the past 12 months? 1@ ❑ 1 the facility has more components than this form accommodates, additional copies of this page maybe attached. Y = Yes, N = No, NA = NotAopiicebte, iD = ldenA85M