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UNDERGROUND STORAGE TANK DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT(Page 2 of 2) VII. INSPECTION HISTORY IYIN Has each follow-up action of section III from the previous inspection been completed appropriately? ❑ Attach documentation verifying appropriate service to this report.) VIII. ALARM HISTORY Attach a copy of the alarm history report/log to this report. Y N NA Is the monitoring system powered on and in proper operating mode? ® ❑ ❑ Has each leak detection alarm since the previous inspection been responded to appropriately? ® ❑ 01 (Attach documentation verifying 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 ®I ❑ service technician? 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 N Containment Sump ID Y N ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ I ❑ ❑ ❑ Are all sensors in containment sumps inspected located to detect a leak at the earliest opportunity? ❑ ❑ Is the spill container free of damage,water,debris, and hazardous substance? T-1 87 U& WEST I M ❑ T-4 87 U& E. M ❑ TANK ID T-2 87 U& W. ® ❑ T-5 91 S/U EAST ❑ ❑ T-3 87 U& MID ® ❑ ❑ ❑ Is the fill pipe free of obstructions? T-1 87 U& WEST M ❑ T-4 87 U& E. ® ❑ TANK ID T-2 87 U& W. ® ❑ T-5 91 S/U EAST ❑ ❑ T-3 87 U& MID ® ❑ ❑ ❑ Is the fill cap securely on the fill pipe? T-1 87 U& WEST 10 1 ❑ I T-4 87 U& E. ® ❑ TANK ID T-2 87 U& W. ® 1❑ I T-5 91 S/U EAST ❑ ❑ T-3 87 U& MID 10 1❑ I ❑ ❑ Is the under-dispenser containment free of damage,water,debris,and hazardous substance? Under-dispenser Containment ID Y N IN Under-dispenser Containment ID Y N INP4 DISP 1/2 AUTO ® ❑ ❑ DISP 22 MAIN-TRUCK ® ❑ ❑ DISP 3/4 AUTO ® ❑ ❑ DISP 22 SAT-TRUCK ® ❑ ❑ DISP 5/6 AUTO M ❑ ❑ DISP 23 MAIN-TRUCK ® ❑ ❑ DISP 7/8 AUTO R ❑ ❑ DISP 23 SAT-TRUCK M ❑ ❑ DISP 9/10 AUTO M ❑ ❑ DISP 24 MAIN-TRUCK M ❑ ❑ DISP 11/12 AUTO ® ❑ ❑ DISP 24 SAT-TRUCK ® ❑ ❑ ❑ ❑ ❑ DISP 25 MAIN-TRUCK ® ❑ ❑ DISP 13 AUTO/RV ® ❑ ❑ DISP 25 SAT-TRUCK R ❑ ❑ DISP 14/15 AUTO/RV M ❑ ❑ DISP 26 MAIN-TRUCK ® ❑ ❑ DISP 16/17 AUTO/RV ® ❑ ❑ DISP 26 SAT-TRUCK ® ❑ ❑ DISP 18 AUTO/RV ® ❑ ❑ DISP 27 MAIN-TRUCK ® ❑ ❑ ❑ ❑ ❑ DISP 27 SAT-TRUCK R ❑ ❑ DISP 19 MAIN-TRUCK ® ❑ ❑ DISP 28 MAIN-TRUCK ® ❑ ❑ DISP 19 SAT-TRUCK ® ❑ ❑ DISP 28 SAT-TRUCK ® ❑ ❑ DISP 20 MAIN-TRUCK ® ❑ ❑ DISP 29 MAIN-TRUCK ® ❑ ❑ DISP 20 SAT-TRUCK ® ❑ ❑ DISP 29 SAT-TRUCK ® ❑ ❑ DISP 21 MAIN-TRUCK ® ❑ ❑ DISP 30 MAIN-TRUCK M ❑ ❑ DISP 21 SAT-TRUCK ® ❑ ❑ DISP 30 SAT-TRUCK ® ❑ ❑ Are all sensors in under-dispenser containment located to detect a leak at the earliest opportunity? M ❑ ❑ Y=Yes,N=No,NA=Not Applicable,ID=Identification