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AUG/17/2021/TUE 02:22 PM Tracy Truck Stop FAX No,209832 2312 P,007
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<br />Has each follow�up action of section Ill from the previous inspection been completed appropriately?
<br />Attach documentation ver' g a inopr/ate serv/ce to this report.
<br />Attach a coPYoftho alas► hist
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<br />Is the monitoringsystem powered on and in proper operating mode? ❑ ' 0
<br />Has each leak detection alarm since the previous Inspection been responded to appropriately?
<br />Attach documen %tion vera In appropriate service to this re ort ❑ ❑ Z
<br />Have all containment sumps that have had a leak detection alarm since the previous inspection been responded to by a
<br />qualified UST Service Technician? ❑ ❑ 0
<br />OEM
<br />List below In Section IX ail containment sumps that have had a leak detect/on alarm since the previous inspection and have not been
<br />responded to by a quallfled UST Service Technician. Contalnrnent sumps listed below require a visual Inspection for damage, wader, debris,
<br />AI�hazardous substance and proper sensor locatlon The results of the visual inspection mutt be recorded In Section IX-
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<br />Is the containment sump free of damage, water, debris, and hazardous substance?
<br />ainment Sum I f�iRi Co talnrnent "IDOY FPR
<br />Wil
<br />❑ ❑ ❑ ❑tainment sumps inspected located to date leak at the earliest opportunity?
<br />er free of dama e, water, debris, and hazardous substance? d ❑ Tank ID PSL C1 ElTank lb ❑ ❑
<br />Is the fill pi a free of obstructions?
<br />TankTanklD 91 HERE ankI❑ ❑xanklD ❑ ❑
<br />Is the fill ca secure! on the fill pl e?
<br />oorroorlo TanklD 91 Tank ID 187 11111 1111 11
<br />3111111111111111111 EEOH=EE
<br />❑ ❑
<br />x
<br />❑ ❑
<br />Is the under -dispenser cgntainment free of dama e, water, debris, and hazardous substance?
<br />Under -Dispenser Containment Ib n;J” "n'VJ'rd;,y{' Under-Dis enser Containment ID w' �� l� d
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<br />Dispenser 1/2 0 ❑ ❑ pis enser 314�� Q
<br />Dispenser 5/6 Cl El Dis enser 7/8 lid d ❑ ❑
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<br />❑ ❑ ❑ d ❑ ❑
<br />❑ ❑ ❑ ❑ ❑ ❑
<br />❑ ❑ ❑ ❑
<br />Are all sensors in under -dispenser contalnment'located to de ❑ ❑
<br />tett a leek at the earliest opportunity? I 1
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<br />Has the monitoring system certlflcation been completed within the past 12 months? I ❑ � nn❑ 121412018
<br />Has the spill container testing been completed within the past 12 months? ❑ ❑
<br />AST
<br />Has the overfill prevenkion equipment inspection been completed within the past 36 months? ❑ x ❑ AST
<br />Has the secondary containment testing been completed within the past 36 months? ❑ 0 Q AST
<br />Has the tank tightness testing been completed within required timeframes? ❑ ❑ 0
<br />Has the line tightness testing been completed within the required timeframes? ❑ ❑ d
<br />Other required testing / maintenance was completed within required timeframe. (List test/maintenance items below.)
<br />Test/ Maintenance: El ElElTest / Maintenance. ❑
<br />Test / Maintenance: 171 El
<br />/ Maintenance: El ❑
<br />Test / Maintenance: El ❑
<br />Test / Malntenanre
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<br />ave all individuals
<br />performing facility employee duties received there uir 0 ee trainin within the pest 72 months? ❑x ❑
<br />/ the facility has more components than this forri► accommodates, additional copies of this page maybe attached.
<br />Y ^ Yes, N = No, NA= Not Applicable, ID = IderVication
<br />Received Time Aug,17, 2021 3:19PM No,6863
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