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UNDERGROUND STORAGE TANK <br /> QV RFILL PREVENTION EOLIPMENT INSPECTION REPORT t ORM (Paso 1 of <br /> TYtte.ltf Aalhln ❑ Instelletion Insoectlorl Q R nxlrr Inca �lon9 _. Mot11h Insoectlen <br /> - — -U,il�_stlS?vrilillFua_v_slitiuu tt�yiuwelltlusl��stiou <br /> IbI al <br /> LAN PAS )otle-5/v "Yot.- zIo N C,cll� wAsN <br /> C <br /> a ►3 Trek ST z S r6l till q 3'2o Z <br /> M. ERGRQ-.0 ATORA.GE_TANKSERVJGE TECHNLOIAN INFORMA—TlOtl - - - - - - <br /> Nems rif U.sf rJt ivit Ttimi :i •ri Potloliii4tu tho 1w;y Eliot IPl_ ,, ; Ql l uiithl_GvNiL . • ryrn ) <br /> 4 rel N KKC3 !r <br /> . I CvntracloslT;',1• tCr. r,,,, IttCo-t'�» # <br /> Overfill Prevenilon I Non Training and Certificalil (Ost ouplicable e(il6c-,!;rile i <br /> Y�CfcO � � R��c . 'Tt�S � 3 >Sc 'TE�►� tL�rw <br /> OVERFILL PREVENTION EOUIPMER INSPECCHON 1NEWMAWN <br /> rt ptl„f d l ) -TiESC eon GeV M� u�M ,� <br /> i i„. . . � - Manalfndutrr GW � ices ,, nc•rah,, <br /> ❑ In aetry =ode ' n11ril Standard 4nea/vl <br /> { ditac6lhllpfpgcEfon proeedures_afld aBllocwtletttatign r�gultedl¢ flxletaliue X74 - - - -- id` ui .yil , r leen N;rcir:: <br /> (�j tank= number sfnrnl r �? � Z bC•1 be, 3 L'• el <br /> Mat is the tank Inside dlnmefer? llnchest r D ` . _ 6 <br /> h Ow rill 111 011 , 1 r Cr ndaiily t nnloini . d7 n Y,::. Mu Y s No ❑ Yr } fL ❑ Yr : . Pio <br /> Is the vent Won eecondedi on elned7Q� ❑� (J_1$Q y�g Ell <br /> �_- 3 5 <br /> J � P41R— d <br /> Q7 etffi Pxev5l�lion.Effu11 ius lu f�� twfastw ct s� - - <br /> ❑ Shs�f O(f Fimv ❑Shuts OR Flow 1-1 Off Finw ❑ Q <br /> tAlhetJa the_oyetfill.tuaventicn�t7ulmnent <br /> response when activated? ❑ _Rer.tric11; Flory Rerhiat; Flov/ ❑Rfl5—tdcts Elow <br /> (r. i� tltnl aypl/ dj 1 statAn/ Alalati <br /> Are flaw Lean lar - Ina :,fled ,n vont Ijping2 Ll iIill _ V• ;y ❑ x” kll U • -- <br /> YY • Ju LJX"%t1 , ,� /� ,L it <br /> set lo � cltv�tc71l7tchcsJront,tzcetfoau.flapkJ U10 T <br /> W)aU5.Wt1.uwT&uI .cbuuci of Ow luck alvrlv�fl p k <br /> the nver6110[as(ention_e4WRIri8niBNhltlLCS2 �d p { b e l % <br /> Is the overfill urevenuon fill oroaer oneratlnnt <br /> cnn�liNnn to rrol whee_the suhstan�e Q&A Q�NQ QLUQ <br /> re8t1h161f> e Nan nwlntelevel? f ,p++ rlfy rl aacBon V.l (Snecffy in section V.l (S_ eec_Ify insertinn V r i ,, u aifylu =rcllorV. t <br /> SUMMARY OF 1NSPECTIO <br /> � Qyg1t41Prettenitaltlu311etiftLik-1 Y_ ao 0 ill �I Y-: 0 oil) p F�aps 4 O�t ttil <br /> -=- - - — - - — -tom _ i- KL=. __— A _. <br /> i T.t' <br /> A11 rterarsQlBllteCLFeiI' nt , ct va ex ,leirl@dju�llls cw,>lion. .fjtty-s71(dtliyllg( �•onunenls roav arts be tl�rb <br /> _ <br /> Ale <br /> CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS INSPECTION <br /> �1�_R_�Y 1 oravontlo„�eau[pmont was In�aciecJ l�.rrgsttslOCLc��yylftt Ca{{fOrulttCQ�o! ::u�.ul�ti4t�r,, <br /> iUbe I diulaWn3GpilIIttM <br /> 1!>al �tvira 7 — - <br /> -- <br /> If lite facility has rnnle components than this fornt accominodates, additional copies of Il pane it he attacil <br /> CFRS = California FhVlfnntltawal Renortinn Systgn ID n Identification . I IST = Inrfergro+ md slorann tank . ICC-_ m ernational Code C <br /> M =_ Audible and vis+ - <br /> R � Ell` ED <br /> SEP 2 6 2018 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br />