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E 12 / 20 / 2018 11 : 12AM FAX 2098236719 ONE STOP MARKET CHEVRON X1 • 0003 / 0004 7z UNDERGROUNDSTORAGETANK PP UE IONATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION S ETION REPORT (Page z of 2) VII. INSPECTION HISTORY _ Has a ch foilowoup action of section lit from the provious insp6Gtion been compieted appropriately? —� – Y N Attae documontot/on vvrifylnq appropriate servieo to this re OW _ ® ❑ - -�L__. _ Vlll. ALARM HISTORY Atte a copy of the alarm history 7 port/log to this report. Is the onitoring_Witem powered on and in proper oporatinq mode? Y N NA Has a ch teak dotectlon alarm since the previous inspection been responded to Apprtiptiutefy7 0 13 ❑ (ANUG documentation verifying appropnato service to thio report.) ❑ HAve II containment sumps , that have hada lock detection alarm since the previous inspection , boon responded to by a qualified UST SefVIC technician? _ ❑ List b Ipw 1fnsection IX, lilt Containment SUMPS that have had a look detection alarm since the previous inspection t nd have not biegn rasp p dgd to by a quollped UST service technician, Contalnmom sumps 11stod below requlro a visual Inspection for damage, wilier, debris, hexer QU3 substance r►nd prepor s*nsor location. The results of the vyfslJal /ns octi4n must bo recorded M section IX. IX. UNDERGROUND STORAGE TANK SYSTEM INSPECTION )s the antainmantsump froe of damage, wator, debris , and hazardous substanca9 _ dontatnment Sump ICT — Y N - T1 : e ular" STP a imp iv YN T2 ; r m " - 0 � tum- STP L7 ❑ T3 ; ' iesel- STP i ❑ _ 0 1� Are all ensors icontainment sumps inspected IoCated to datoci a leak at the aarlimAt 4pRortui Is the III conLalnpr free of damage, ii water, debris, and hazardous substance? C7 TANKT1 : Regular _ . . _ T1 Die,seI _ �' ,y �I ❑ T2� ►utr' ® C3 Is the f I pipe frea of abatructions ? - WIMD I , • E O ITZ� R alar ❑ T3 ; Diesel remium --- 0 0 ! 9 ' Is the fil cap securel on t110 fill pipe? 13T9 ; Regulet —� . —. eel JK D T2 ; Premium - -- — ® ❑j . . . . . _. _ . _. --- • - _ _ Is the u gicloradisPonsor containment iroe of dams,go, water,d_debris , and hazardous subvtance? ❑ M Undbr-dlsponsor Contoinment i[7 – -�^-- -- -� _ — Y N N Under-dlsponsor Contatnmont to Y_ N N_ 1 /2 3/4 WPO A El 00 Are allnsors in undor4isponsor dQntainmont located to dEl a 13 eter! sy kiak at the earllo,t o portunity7 D3 El 0 X. TESTING AND MAINTENANCE Y N NA DATE LAST f�As the monitorng system Wification boon completed within the past 12 months? — PERFORMEu Has the pillpill contairibt tasting been compintnd wiihiri tits past 12 montFi37 - — - ❑ 12/5/1 $6�0_ Has the verfill prevention equipment inspection been Completed within 1116 past 36 months? 12/5/18 Wns' thr, econdAry containment testing boon completed within the past ;i6 tttonths? Has the ank tightness tasting been compieted within regntred timelrAmes7 © ❑ 1 /17/17 lilts the the tIgntnesa testingboon completed within tho required timeframp::9 ri Dthar re wired tasting / mainto lain was_ camplot4d within roquiro�l timc/ramo. List tast/rraatrrtnrronroitems below, - ❑ ® ` Test Maintenance, /;fir Quality tea • ua.,..� t Test Maintenance: 'rest Maintonunca, ' ,a. —�. . - - �_... ._ — © ❑ Test Mainten n -- __ _ ❑ ❑ -- - a ce , ---- -.. Test Maintenance: -- - - - ❑ 13 ❑ _ Test Maintananco: - —� XI . FACILITY t`MPLOYEjw TRAINING © - ❑ Nava all ndividualc performing facility employee duties received the requirod ;ctlity ompiayee training within the past 12 monthA? y Y N it If tho fp illy has marc compo»ants than this tom► accommodates, attditlonal copies of this pogo may pe Offachad