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UNDERGROUND STORAGE <br /> TSYSTEMDESIGNATE ? <br /> CRLERATOR MONTHLY INSPECTION REQ <br /> Facility Name,, Lower Sac Chevron <br /> _ . � <br /> inspectiaa <br /> WO fiver Sec <br /> � Sttttlt�y <br /> tear ernduet #nsvo tion_ <br /> Al <br /> ex.labbari <br /> Eczcrrra�€i�rz #C.t�de't'tsurr�al�ertr��-�tian Nn.= � �,�* � ' <br /> u — <br /> 5243897-UC <br /> --_ �xttlratTfWe <br /> t7t1t11N1urAN L 1A1 AIt DIST[lRY <br /> P. tc thze u�cnttcuare s stir <br /> veered on enc#rerct renting rnode"r <br /> itOrin m sot eunvntt% shujq t sfc alarms? (n <br /> " 15 the Alarm He _ <br /> 90d UsRq►ortlbg for the previous month availahk,and has It been rrv3ew #bytt <br /> "ch razor'► .t ttaclr o a rhe alarm hist n a err rdrrs rrrr is�v,nni r rn k <br /> xlatat fae#re vious month bean ,' 4 <br /> t to e Z - n <br /> 5 UST SYSTEM AVSPELTION ____�_ � � <br /> Are tank-tap cantainmeat sumps free of waterAU"abp ,debris,and harardous wbstaoce? .pare.J fir+r�Nim+wa, via qr <br /> jj ort rb.lrnr 4:Srwps xAn+e on'arornr Jm aaivred to akr pmr Maar6.mr tw wRre+rd po q+w�t�/xd mirror aecAm,�:ram Am MW � <br /> ' j o4ibiraftdlhtMrrr dtaraarLJbcWwtaEarion atrvinshorfdihrAwsahrdr0lltitrc d, � <br /> L f1 )j No sumpsa#arm Yes No No sumps alarm rj, ala ' 0 <br /> n Stan Location: sumpLocation, <br /> l ' Sum !ainion Sum Location: 00 <br /> 6, Are s <br /> Pill bttckebs containment structures fine of water,debris,and hawdous substance? 07 <br /> Yes No NIA Yes No N/A OO <br /> }Ia»k 1 ICt R dinar Tank 3ID- Premium <br /> fank2ID Plsts Tank 4ID- I— <br /> T 1 re renderA encs r c�3ntai€went wean fee of water.debris,and hazardous substance? O 0 <br /> (, _ Yes No NIA "des No NfA <br /> i7i' rtiser t, Dis -4110 <br /> �'1 I3 ser 318 CD <br /> Di er-11112 <br /> CD <br /> 11 D` a-S16 D' r 1311 <br /> 1516N <br /> Sx tion is i loci with' under-dis confiainmera : � <br /> Yes No NIA <br /> b /2 <br /> CD <br /> .T ser- 14Dispenser-11112 <br /> i Tlis mases Di user-13118 r+ <br /> 0 <br /> -7t9 Ili user-1 If ` <br /> PAPERWORK INSPECTION Yes 14a NIA �ri1c.Roiaik Q. <br /> , 11ta } ret Cr rrtifz_eatiean wss completed within the past 12 months'? 01,M011 <br /> I0. t «mtaittmttt trssomisleted within the required time frame? �2PZ <br /> �. w <br /> !Ir !socket i�earttabnrnant Stx tcture)ttsting completed within the past 12 months? 0 w7a0l <br /> 12 Tank l ghttn s testing r plett�l within the required time frame'.' <br /> 13. Line tilNrtess testing completed wtthln the required time dame? <br /> cher <br /> U" testin tnaintextattce wasoom leted within required time frame? List tesv'rr amfenan <br /> m <br /> 3 "!'eitt114!lttin e. � ___ <br /> 0 <br /> fr <br /> FACILITY EMPLOYEE TRAINING <br /> ! Ib to tfst uired on the jab training w'ithirt thcast <br /> 77 <br /> a htresl w'edtin the t 3Q da^s received th:required crwth€s-` a vitinirt <br /> r tw dttSi�`ers iiv ale,t otrttnraats"tertion on the following page,Those issuetrequire <br /> 01 ;: <br />