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_UNDERGROUND STORAGE.TANKl. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT pa a i oft VIL': ;:::INSPECTION HISTORY. ...........:.::..: ::..:........, ....._.....4-. Y .... N. Has each follow•up action of section III from the previous Inspection been completed appropriately? (� ...::.:. _......: VII .::::.......... ALARM HISTORY Attach a copy of the alarm history report log to this report. Y N i NAI Is iha monitoring system powered on and in proper operating mode? 11 -the facility/las more components than this form accommodates, aaareonal copies of this page maybe Has each leak detection alarm since the previous Inspection been responded to appropriately? (Attach documentation verilying 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 qualified UST service technician? ❑ ❑ List below In section IX, a// containment sumps that have had a leak detection alarm since the previous Inspectlon and have not been responded to by a qualUled UST service technician. Containment sumps listed below require a visual Inspection for damage, wafer, debris, hazardous substance, and propersensorlocation, The results of the visual Inspection must be recorded In section 1X. iX. ' UNDERGROUND STORAGE TANK SYSTEM INSPECTION Is the containment sump free of damage, water, debris, and hazardous substance? Containment Sump ID y Sump ID Y NEl Q ❑ ❑ElEl UNContainment El I El Are all sensors in containment sumps inspected located to detect a leak at the earliest opportunity? El El Is the spill container free of damage, water, debris, and hazardous substance? TANK 87 ® ❑ DIESEL ❑ ID 91 ❑10 1 F1 Is the fill pipe free of obstructions? 87 0 IEJ I DIESEL ❑ TANK ID 91 IN in I 1EJI0 is the fill ca securely on the fill pipe? ID 87 10 1 DIESEL TANK 91 IN IEJ I I ❑ I El Is the under-disponser containment free of damage, water, debris, and hazardous substance? Under•dlspenser Containment 1D I Y I N I NAI Under -dispenser Containment ID Y NINA 1-2 ❑ 34 1❑1010 1❑ 5-6 ®in Ell❑ 7-8 SAT 8 ® ❑ ❑ ❑ Ulu ❑ ❑ ❑ Are all sensors in under -dispenser containment located to detect a leak at the earliest opportunity? ❑ I ❑ TESTING AND MAINTENANCE - Y .N NA DATE PERFORMED LAST Has the monitoring system certification been completed within the past 12 months? 7-10-19 Has the split container testing been completed within the past 12 months? ®M307 7-1019 Has the overfill prevention equipment inspection been completed within the past 36 months? ® 17110 11-2019 Has the secondary containment testing been completed within the past 36 months? ❑ 2 27A 8 Has the tank lightness testing been completed within required timeframes? Has the line tightness testing been completed within the required timeframes? ❑ ❑ Other required testin / maintenance was completed within required timeframe. Ust test/maintenance Items below. Test / Maintenance: Test/ Maintenance: ❑ ❑ Test/ Maintenance: El Test / Maintenance: Test/ Maintenance: Test/ Maintenance:__ ❑ ❑ El p� Xi. FACILITY EMPLOYEE TRAINING Y N Have all individuals performing facility employee duties received the required facility employee training within the past 12 months?IMI I El attached.