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-n <br /> U_ <br /> oVAIrjK SygTTIQN gEPOgT <br /> o v NSIGNAI UNDERGROUND STO�CT ysprzo 6 <br /> =It D UST OPERATOR MONS °" (7 <br /> N rpt 7878 March i Ghewon CaY St °n pate: 10/42016 <br /> rested Lane bon <br /> . noelCode c und�a1ef°f Of eounauaine8250oe3-UC��re�a EfljOrt. t53a)749-90� �- Nle <br /> N Q <br /> No <br /> N 0 �.pµY <br /> N m <br /> � O the monitorin . ,stem MONITORING PANEL/ALA ? ed by the <br /> :7—h � ;e �Hn s stem not eanentl showin an leak a awnswered on and in ' aad has it been!eview ion ate" <br /> atm USTatory RePort/tos for the gevioas monthavallabk. to <br /> t� Y►I <br /> O eaCD alter for the ttM Aumonth Dean t o/arrn�t �•ael asr"°r ro[Jere f was••fes.' skip <br /> 3 o.ad <br /> tank- CrJON ee'! ,vde:7iec6aurmr has not resP°"'ded <br /> (D n 6.,Stop containment UST SYSTEM niSPh�a s substatt fed 9�tho Kyprr. � No <br /> _ _� t a. mu a�eTalone M�avxTd mfice of W wit tr jh°ald K°naitrd X . <br /> (D /hr°tarar.Qar+er.nemrm <br /> U) t Location:PPEMIUM Ya No sumt-oeadon:DIESEL <br /> ti1lbMron:lJN E DED X Sum1Ono�substance7 yes No NIA <br /> tM <br /> (.Q � cOO�inrnent structtttes free of water.debris.and hamrd < <br /> ID—PREMIUM Ya No N/A Tank 4 ID- <br /> -U <br /> D-- ID—UNLEADED Tank 5 ID— Q <br /> �-DIESEL Tmk6ID- No N/A <br /> m ter-dis nser containment ous substa"c°' Ya <br /> of water,debris,and hvatd ,. <br /> M (n Cr 12 Yes No N/A 9/1 <br /> p Di nser- 0 X <br /> er-3/4 Dis nser-11112 <br /> er-5/6 pis nser—Ofl,t X <br /> w-7/8 Dis user-15/16 <br /> action is properly located witifin under-dispenser containment. yes No N/A <br /> Yes No N/A <br /> r- 1/L Dis nser-9110 m <br /> 3/4 Dis nser-11112 x <br /> 6 Dis nser-13114 X <br /> Dis nser- 15/16 <br /> yes No NIA Date Done <br /> PAPERWO INSPECTION 1111812014 <br /> otem Certification was com leted within the t 12 months? X 1111812014 <br /> o tors were tested/certified within the past 12 months? X 1111812014 <br /> t containment structure testingcompleted within the t 12 months. X <br /> m ass testing completed within the required time frame? X VPH <br /> o An[ainment tests com leted within the aired time Same? <br /> X VPH <br /> D eek Detection completed within the required time frame? 7C ^ <br /> o ed testin maintenance was completed within uitad time flame? (List test/maintenance items below.) <br /> I 1 , <br /> m est/Maintenance:Air uali !Va or <br /> X 101812014 <br /> 3 �gt/Jygittteoance: 'n <br /> (D - V ' <br /> nt FACILITY EMPLOYEE TRAINING Yes No NIA N <br /> cn em to ces received there mrcd on-the- ob trainin within the est ear? X <br /> o i hi�within the est 30 da s received the required on-the=ob trainin ? X O <br /> t em to les <br /> cn -.., in the"Comments'section on the following page.Those issues require corrective action from <br />