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10878 North Highway 99 PR0231598 <br /> May 26, 2021 Program: UST <br /> PHOTO 2: 6/19/2020 DO re ort with incorrect test dates. <br /> DESIGNATED UNDERGROUND STORAGE TgNK OPEI'TORATOR VISUAL INSPECTION REPORT p x.t x <br /> Has each folio <br /> AttacTANK <br /> Ah'ICh din»ntaI ive olI g o III from the o,llouvs hapecllonEbeen come eted eHISTORY <br /> priataly7 <br /> reserweero d Y N <br /> is the h a copy of the a/ VIII. ALARM HISTORY ❑ <br /> montionng system arm h/story reporN <br /> Hese Powered on antl In - to�l s Ort' Y N <br /> (Adach d leak detection.lam,eines the ro Po Per operating model <br /> o.umenrarl.n vo;;,',.n,mth erevm ❑ ❑ <br /> Have all C.nt.inma a inspection been responded to appropdateq? <br /> of <br /> be teennipien7nt sumps,that Neva hetlaI Mtn�mpon.f ❑ ❑ <br /> resp ow In aecdon eek detedion almm since the previous Inspection,been responded to b <br /> x ui eontalnmane sum r a gdarnm usr A ❑ ❑ <br /> heterd�s robafangre ay usr Ps tlraf have hatl a leak detaedon al,.m since Me <br /> and "m'ce raanmclan.Confemment au Previous Inspectlon antl hew not bean <br /> sans..l..adon.1ha mPs Ifafed b_jIebw mqufre a visual lnapecdon for d.mape,wafer,define, <br /> Is the c.ntsinme IX• UNDERGRO ND STORAGE TANK SYSTEM INSPECTION on/x <br /> M sump nae of damage,water,debris,and hazardous stsn.7 <br /> ubs <br /> Containment p ID Sum <br /> Y N Containment sump ID Y N <br /> ❑ I❑I❑ <br /> Are all sensors in conal ❑ ❑ ❑ <br /> then sumps inspected to ❑ ❑ ❑ <br /> Is the Spill container free d dame e, cetetl b dated a leak.1—.1— <br /> I <br /> oppodunityt ❑ <br /> g water,debris,antl,� <br /> KID hazardous substance?TAN <br /> ❑ 1qj❑ <br /> Is the fill pipe free of obstructions? ❑ ❑ <br /> TANK ID ❑ ❑ <br /> Is the fill cop soc"'y on the fill ❑ ❑ <br /> piper <br /> - TANK ID ❑ ❑ <br /> Is the underdispene 1 containment free.!damage,water,debris,and herardous s�ubatnrrce7 ❑ <br /> Underdisp Ser Containment ID Y N N Under-dispenser Contalnmanl lD Y N N <br /> I 13 ❑ ❑ r-, <br /> ❑ <br /> ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ 13 ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> Are all se....in under11.psnsar containment located to doted a leek at the earliest opportunity? I ❑ ❑ <br /> X. TESTING AND MAINTENANCE Y N NA DATE usr <br /> Hes the monhodng system certlhcstion been completed within the past 12 months? PERFORMED <br /> ❑ u-n-I <br /> Hes the spill container testing been completed within the past 12 months? ❑ � <br /> Hae the overfill prevention equipment inspection been completed within the poet 36 monm.? ❑ ❑/ <br /> Haa the Secondary containment testing been completed within me past ao months? IK[ ❑ ❑ S ,/ <br /> Has the tank tightness testing been completed within required tinnefrannes? ❑ ❑ ❑ <br /> Has the line tightnemIesting been completed within the required timeframes? ❑ ❑ ❑ <br /> Other re uired tostin /maintenance was cont leted within ui dtimeframe.List tasdmaintsnence hems below. <br /> Test Maintenance: AMR ❑ I0? <br /> Test Maintenance: ❑ ❑ <br /> Test/Meintenence: ❑ ❑ <br /> ❑ ❑ <br /> Teat/Malnlenance: ❑ ❑ <br /> Test/Maintenance: <br /> ❑ <br /> Test/Maintain <br /> XI. FACILITY EMPLOYEE TRAINING Y N <br /> Have all Individuals pSrforming facility employee duties received the required facility employee training within the past 12 months? ❑ <br /> ff the faclllty hes mora comp <br /> onents than tit/a Porro accommodates,eddldonal copies of fhfs page they be attached. <br /> Yea N a No,NAa Not Applicable,ID=klerdlace0on <br /> Lydia Baker, SR. REHS Page 2 of 8 <br />