COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

If the facility has more components than this form accommodates, additional copies of this page may be attached. UNDERGROUND STORAGE TANK DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT Wag e 2 of 2 VIL INSPECTION HISTORY Y N Has each follow-up action of section III from the previous Inspection been completed appropriately? Attach documentation varMng appropriate service to this report.) ® ❑ VIII. ALARM HISTORY Attach a copy of the alarm history report/log to this report, Y N INAI Is the monitoring system powered on and in proper operating mode? 9 ❑ Has each leak detection alarm since the previous inspection been responded to appropriately? (Attach documentation vedVng appropriate service to this report.) Have all containment sumps, that have had a leak detection alarm since the previous Inspection, been responded to by a quallfled UST service technician? El ❑ 1:1 ❑ IN List below In section IX, all containment sumps that have had a leak detection alarm since the previous inspection and have not been responded to by a qualified UST service technician. Containment sumps listed below require a visual Inspection for damage, water, debris, hazardous substance, and proper sensor location. The results of the visual Inspection must be recorded in section IX. IX, UNDERGROUND STORAGE TANK SYSTEM INSPECTION is the containment sump free of damage, water, debris, and hazardous substance? Containment Sump ID Y I N Containment Sump ID �Wnn Y N 1171 1771 Are all sensors in containment sumps inspected located to detect a teak at the earliest opportunity? El Is the spill container free of damage, water, debris, and hazardous substance? 87 DIESEL TANK ID 99 Is the fill pipe free of obstructions? 87 0 IEJ I DIESEL I NI EJ TANK ID 91WVIEl I El is the fill ca securely on the fill pipe? 87 10 JE1 I DIESEL TANK ID 191 Is the under•dispenser containment free of damage, water, debris, and hazardous substance? Under -dispenser Containment ID Y N N Under4spenser Containment ID Y N N 1m2 ❑ 3-4 171 1 1011 1 5-6 7-8 I Li Ell 01 Ell 1❑ ❑ 0 Lj❑ SAT 8 1 � L10 10 Are all sensors in under -dispenser containment located to detect a leak at the earliest opportunity? ❑ X• TESTING AND MAINTENANCE Y N NA DATE PERFORMED LAST Has the monitoring system certification boon completed within the past 12 months? Has the spill container testing been completed within the past 12 months? Has the overfill prevention equipment inspection been completed within the past 36 months? ® ®❑ ® = ❑ 7_10_19 7-10-19 112019 Has the secondary containment testing been completed within the past 36 months? ® ❑ 2_27_18 Has the tank tightness testing been completed within required timeframes? Has the line tightness testing been completed within the required timeframes? Other required testing I maintenance was completed within required timeframe. fUst test/maintenance Items below Test i Maintenance: _ Testi Maintenance: I El - "- Test/ Maintenance: Test / Maintenance: ❑ _= Test/ Maintenance: Test I Maintenance: 0 ❑ XI, FACILITY EMPLOYEE TRAINING Y N Have all Individuals performing facility employee duties received the required facility employee training within the past 12 months?