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C_ IO <br /> NnrDty�SIGIYgi UNDERGROUND STOKA('fNL,..._Y�NSN�Tf()N ftF,POKT <br /> O nryA me. Maw ED UST OPERATOR MO�� ctran (7 <br /> ort>Oss; 1ti lancpl Chevron r.i,Y gpekWn ' 6 _ <br /> C}1 o st�y�B III Lane ��Date; 1Q�� <br /> Q tatlOmll Code Uy t UPcra/or('onduning biYtxc unu Uale Garea9a EaPrrsti ,exL <br /> 9892 A Me <br /> lure: ^af <br /> N3 Cen „-- -UL : ( 3 )749 <br /> uPhonepYl <br /> N u N/AO 8250093 <br /> tQ�I <br /> CD � fa the °1OnitoHn MONITORING PANEL/ALARM NiS.fpRY W <br /> mop a Stem wercd—____ In ppde? the <br /> k9hc Alarpr Fi sto atom not currcn I and <br /> an leak aWn'a9 h been revicwod Wim• <br /> 'as aced US T -°P°Nlog fof�itrc previous mond)available•and ha9ro/h_Is Int clJnn <br /> n a/arrn for t1�� /Atroch a cans olrhe dorm hl>t >et <br /> NIOW mprn6 been tO -_rr rn Item I was"Y¢>."aklP t J <br /> 'e rank-to tal UST SYSTEM INSPECTION p Nor¢:1/Or on>w ha>rat rtrpnaded lo. a^d <br /> _ —• oe.%a. Swnv"whensA ort sumps N'eC of water,debris.and hazardous subs � srvr to�lr nu P� <br /> tQ °1 "ae'4 rhe oma 1�d M rhr r ml mart Ar aw ke ld"atloel Yea No <br /> tae°/ Axvmrnranrm 1111111,a N X <br /> `< W n L°cation:PREMIUM Ya No tion:DIESEL <br /> 1-Oration: UNLEADED X Sum Luca <br /> s ill X Sum Location: x7 <br /> buckets CD <br /> containment structures free of water,debris,and ha>�d°'�substance? Yes No NIA <br /> 3IID_ <br /> to PREMIUM Ves No N/A O <br /> 2 ID_ UNLEADED Tank 4 ID- <br /> ADED Tank 5 ID- <br /> m 3ID-DIESEL Tank 61D- <br /> ? oder-dis ser containment areas of water,debris,and hazardous substance? Yes No N/A <br /> O <br /> w tsar- 1/2 Yes No N/A Co <br /> ser-3/�4 Dis ser-9/10 <br /> serser-516 Dis ser- 11/12 X <br /> Dis nser- 13/14 X <br /> ler- 7/8 Dis ser- 15/16 m <br /> tection IsPrrO ly located within un er-dis ensercontainment. <br /> s No N/A Yes No NIA <br /> :r- 1/2 YeDispenser-9/10 <br /> 7 <br /> T-3/4 Dispenser— 11/12 QL) <br /> r—5/6 Dispenser— 13114 X —11 <br /> .- 7/8 _ Dispenser- 15116 X <br /> o <br /> I PAPERWORK INSPECTION Yes No N/A Date Done <br /> v > <br /> System Certification was completed within the past 12 months? X 1111812014 r <br /> Detectors were tested/certified within the past 12 months? X 11118120JA <br /> O t (containment structure testing Completed within the past 12 months? X 11/18/2014 <br /> 7 tss testing completed within the required time frame? n <br /> Z X VPH D <br /> ° containment tests Completed within there aired time frame? X <br /> CD VPH <br /> 3 oak Detection completed within the required time frame? X � <br /> ( 01 <br /> :d testin maintenance was com leted within r aired time flame. List test/maintenance items below V <br /> � <br /> esdMaintenanci Air Quaut /va r X <br /> 101812014 <br /> C) alntenance O <br /> C11 FACILITY EMPLOYEE TRAINING <br />