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UNDERGROUND STORAGE TANK Feach TED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 2 of 2) VII. INSPECTION HISTORY ow-up action of Section III from the previous inspection been completed appropriately? Y I N Attach documentation verifying appropriate service to this report. g) 1 ❑ VIII. . ALARM HISTORY Attach a copy of the alarm history re ordla to this report. Y N NA Is the monitorin2 system Rowered on and in proRer operating mode? ® ❑ ❑ Has each leak detection alarm since the previous inspection been responded to appropriately? 1:1 El documentation verifying a Ya fate service to this report. Have all containment sumps that have had a leak detection alarm since the previous inspection been responded to by a ❑ ❑ ualified UST Service Technician? List below in Section IX all containment sumps that have had a leak detection alarm since the previous inspection and have not been responded to by a qualified UST Service Technician.Containment sumps listed below require a visual inspection for damage,water,debris, hazardous substance and proper sensor location. The results of the visual ins tion must be recorded in Section IX. IX. UNDERGROUND STORAGE TANK SYSTEM INSPECTION Is the containment sump free of damage,water, debris, and hazardous substance? Containment Sump ID Y N Containment Sump ID Y N ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ .Are all sensors in containment sumps inspected located to detect a leak at the earliest opportunity? ❑ ❑ Is the spill container free of damage,water,debris,and hazardous substance? Tank ID Spill Bucket-87 East 87 West A'1 ❑ 1 Tank ID Spill Bucket-Diesel East $1 ❑ Tank ID Spill Bucket-91 Q9 ❑ Tank ID Spill Bucket-Diesel West ? ❑ Is the fill pipe free of obstructions? Tank ID 5pill BUCKet-51as , 51 West ❑ Tank ID b13111 tsucKet-uteselas ❑ Tank ID Spill Bucket-91 U9 ❑ Tank 1D Spill Bucket-Diesel West ❑ Is the fill cap securely on the fill pipe? Tank ID Spill Bucket-87 East, 87 West 31 ❑ I Tank ID Spill Bucket-Diesel East ❑ Tank ID $pill Bucket-91 991 ❑ I Tank ID I Spill Bucket-Diesel West ❑ Is the under-dispenser containment free of damage,water,debris, and hazardous substance? Under-Dispenser Containment ID Y N NA Under-Dispenser Containment ID Y N N Dispenser-1/2, ® ❑ pDispenser-23124, 5 ® ❑ ❑ Dispenser-5/6, 718 (2 ❑ ❑ Dispenser-25128,26127, 27 ❑ ❑ Dispenser-9/10, Qg ❑ ❑ ❑ ❑ ❑ Dispenser-1 ® p p ❑ ❑ ❑ Dispenser-17118, 19120 ® ❑ ❑ ❑ Cl ❑ Dispenser-21, 21122, 22123 P9 ❑ ❑ 1 ❑ ❑ ❑ Are all sensors in under-dispenser containment located to detect a leak at the earliest opportunity? ® ❑ ❑ X. TESTING AND MAINTENANCE Y NINA Date Last Performed Has the monitoring system certification been completed within the past 12 months? ❑ 8/4/2020 Has the spill container testing been completed within the past 12 months? ❑ 8/4/2020 Has the overfill prevention equipment inspection been completed within the past 36 months? ❑ ❑ 9/28/2018 Has the secondary containment testing been completed within the past 36 months? ® ❑ ❑ 12118/2019 Has the tank tightness testing been completed within required timeframes? ❑ ❑ ® NIA Has the line tightness testing been completed within the required timeframes? ® 1 01 ❑ Other required testing/maintenance was completed within required timeframe. (List test/maintenance items below.) 8/4/2020 Test 1 Maintenance: ❑ ❑ Test I Maintenance: ❑ ❑ Test 1 Maintenance: ❑ ❑ Test 1 Maintenance: ❑ ❑ Test 1 Maintenance: ❑ ❑ Test I Maintenance: 1 01 01 1 XI. FACILITY EMPLOYEE TRAINING JY N Have all individuals performing facility employee duties received the required facility employee training within the past 12 months? ❑ 1 the facility has more components than this form accommodates,additional copies of this page may be attached. Y=Yes,N =No,NA=Not Applical*,ID=klen%cation LOVES-223-08/24/2020