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f!N bERGRdEIh>s3:STORAt fie IF 6F I W. I ©ES GNATEU ti,NDERGRWN©':STQRAGE IF F TANK OPERATQR �IISUAh. INSPECTION ItEPpRT a z of�:x IF 1 111i. _ . : . :INSPECTION 001 FF'IF 44 Has each fellow=up action of Section Ill from the previous inspection been completed appropriately? Y ; . N . Attach documentation vert tag a plate service to ibis rt. ilei D Vile ALARM "i5'r m Is .the monitarlpQ system 00wered on and in proper operating mode? >tCl Ej Has eacti - leak .detection alarm since the . previous inspection been responded to appropriately? D Attach documentation ve . t ro tie to service to this rt Have ail containment sumps that have hada leak detection alarm since the previous inspection been responded to by a ❑ ❑ ualltied UST Service Technician? List below In Sectlon IX an containment stumps that have had a kak detectlon alarm since - the , previous inspection and have not been responded to by a quallMd. LIST Service Technician, Containment sumps listed below require s visual inspection for damage, , water, debris, hazardousIF + substance and proper sensor locallom The results of the visual Inspection must be recorded In Section 1X. IF I11N[7iEl�G 1Np aTORAQE TANK 4Y�C M INSPF�'C10# IF Is the contalrimentsymp free of damage, water, debris, and hazardous substance? Containment Sum ID Y N Containment Sump OF Y N ❑ ❑ D D ❑ ❑ ❑ ❑ D D ❑ D Are all senson; in containment sumps inspected located to detect a leak at the earliest opportunity? ❑ ❑ Is tt a spelt writs! Vier free of dafftaoo water, ctebrts and #hazardous substance? Tank 10 *pill uc e ❑ I Tank 10 ❑ ❑ Tank ID Spill tSUCKetmQ tank ID ❑ 1 ❑ Is the fill Im bat ions? Tank ID apiff IN D Tank IE[ O ❑ Tank ID *pill uc e Q Tank ID IF CI D . Is the fill caP securely on the. fill .pipe? Tank ID Spill blUCKSloar © Tank fiD ❑ ❑ To* tt? OP111 0UVKeXftV1 M .01 Tw* fit? I I Cal D Is the under dis sercontalnment free of dams e, water, debris, and hazardous substance?: Unde �Ispetnser Containment ID Y N:: NA UnderO ser Containment ID Y: N N ® ❑ ❑ ❑. ❑ ❑ s ❑ D D ❑ ❑ g !spenseraWS 99 D ❑ ❑ Dr 4D in ❑ ❑ 01 D D ❑ D 01 ❑ ; ❑ ❑ D D D IF ❑ ❑ Are al! sensors in under dispenser containment located to detect a teak at the earliest opportune ® D :. D X.IF IF F . . TESTING AND MAINTENANCE Y N NA daI . te t est ' F +IPerformed Han the monitorings stem coilifination boan. complatad within the past V months? D 2/21 /19 Has .the. spili container testing been completed within the past :12 months? ❑ Has the overfill prevention equipment inspection been completed within the: past 36 months? ❑ ❑ Has the, seconds containmenttesti been completed within the past 36 months? !$) O U Hasthetank sst8stt beerretim wtttiitrne tkneframs? �} E} sr NA Has the Ilne tightness testing been. completed within the required timeframes? ❑ NN/A Other required testing / maintenance was completed. within required.timeframe. (List tost/maintenance items below.) Test/ Maintenance: D ❑ - Test / Maintenance: 0 ❑ IF Test/ Maintenance: ❑ Or Test / Maintenance: 0 d Test / Maintenance: ❑ Cl Test f Mahtenance: F7 ❑ IF 1. KI. . . FACILITY :EMPLOYEE TRAINING Y. N . Have all individuals performing facility employee duties received the required fagility employee. training within the past 12 months? � ❑ I file todfity has .more components than this form accommodates, additional capias of this page may be attached. Y = Yes, N = No, NA = Not AppkaWe, lD = W&Wa4on TESORO - 68152 - 02/06/2020