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It the facility has more components than this form accommodates, additional copies of this UNDERGROUND STORAGETANK DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Paf e 2 of 2 VII. INSPECTION HISTORY Y N Has each follow-up action of section III Attach documentation varMng appropriate from the previous inspection been completed appropriately? service to this re ort. VIII. ALARM HISTORY Attach a copy of the alarm history report/tog to this report. Y N INAI Is the monitoring system powered on and In proper operating mode? Has each leak detection alarm since the previous inspection been responded to appropriately?[� documentation verifying appropriate service to this report.) El(Attach Have all containment sumps, that have had a teak detection alarm since the previous inspection, been responded to by a quallfled UST technician? ❑ 1:1 toservice 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 tachniclan. 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 Containment Sump ID Y N El 0 ET 17 ❑El dNN El Are all sensors in containment sumps inspected located to detect a teak at the earnest opportunity? Is the spill container free of damage, water, debris, and hazardous substance? 87 Lj 10 DIESEL El 1Z TANK ID 91 is the fill pipe free of obstructions? 87 19 IQ I DIESEL ® ❑ TANK ID 91 is the fill cap securely on the rill pipe? 87 ❑ DIESEL TANK ID 91 Is the under•dispenser containment free of damage, water, debris, and hazardous substance? Under•dispenser Containment ID Y N NAI Under -dispenser Containment ID Y N N 1-2 0 11 01 ❑ U111 3-4 ® El Ell ❑ I ❑ M 1 0 ❑ ❑ ❑ 7-8® ❑ ElSAT 8 ® F1❑ ❑ 0 ❑ ❑ Are all sensors in under•dlspenser containment located to detect a leak at the earliest opportunity? N 1 ❑ X. TESTING AND MAINTENANCE Y N NA DATE LAST PERFORMED Has the monitoring system certification been completed within the past 12 months? _ is 7_10_19 Has the spilt container testing been completed within the past 12 months? ®❑ 7-10-19 Has the overfill prevention equipment Inspection been completed within the past 36 months? ®❑ ❑ 11 _2019 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 / maintenance was completed within required timeframe. 10st test/maintenance items below. Testi Maintenance: I El-_ Test / Maintenance: _ Test / Maintenance: ❑I El _ -- Test / Maintenance: ❑ El Test/ Maintenance: Test] El 11:1 Test t Maintenance: ❑ - Xl. FACILITY EMPLOYEE TRAINING Y N Have all Individuals performing facility employee duties received the required facility employee training within the past 12 months? page maybe of/ached.