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Site Number l� l �� Date B/►SEItAENT SUREY rfthereris.no basemen legve Ispac le blank r " Do the UST's have water-tight sumps to capture and contain any releases? (visually verified) Do UDCs have UDC sensors tied into the TLS? Are the UST High Level Alarms set at 95%and Max Level Alarms set at 100%in the TLS?Is there a visual/audible overfill alarm at the tank pad and an audible overfill alarm set on the TLS? Are the storm drains in front of the C-store clear of debris and do they carry away liquids to prevent pooling? Has the site drainage system been modified in the past 12 months? _ Have any new structures or equipment been added/installed within 10 m of the basement walls? Is there any bulk storage of chemicals or products in the basement? ii- J 2 U I G Are service entries in basement walls adjacent to forecourt areas fully sealed with no visible ground water ingress i::N\11R[")N N1 ENTAL Do Electrical conduit/ducts from the forecourt area enter the c store building above ground,or provisions shall be provided for an intermediate containment If basement is NOT normally vented to atmosphere(closed walls and ceiling)then is there a forced ventilation system that starts if the LEL limits are reached. Is the tank pad surface in good/tight condition?Pad should be liquid tight paving/concrete to prevent spilled fuel from migrating through soil and into the basement Are all rooms in basement open for shared ventilation? Are emergency lights EX Rated? Does the basements have Flammable Gas Detection systems:With functioning audible and visual alarm indication? 1 st Alarm Point set at 20%LEL:Triggers evacuation of any occupants in basement and investigation of the alarm source 2nd Alarm Point set at 40%LEL:Triggers Emergency Shutdown(ESD)of all electrical equipment in the basement area,a complete shutdown of the forecourt el system,and evacuation of the site. Verify the Detectors are: -located in areas of potential ingress of vapors&close to floor level (usually 10-24 inches above floor) -linked to a visual&audible alarm located in the basement and at a manned location on sites(e.g.Cashier station) Does the CStore have signs posted with instructions to attendants on what to do n case of LEL Alarm? Are sources of ignition in basement either be isolated by and Emergency Shutdown or shall be removed from basement areas? Are all non-essential electrical equipment by automatically isolated by the ESD? Are there any gas-fired equipment with pilot lights? Is essential electrical equipment-gas detection,emergency lighting and any ventilation must be EX rated for use in potentially explosive atmospheres? Is all other non-rated equipment removed or tied into the shut-down on ESD,this includes: -Gas and electric heating and ventilating equipment -Incoming electrical main switches,fuses and meters -Electrical control or switch panels -Electrical(mains,battery),gas/diesel powered motors for generators or compressors -Standby power battery packs Have the detectors been tested per manufacturers guidance by a certified Technician and did everything pass or were repairs made?Where are the inspection records retained? Has testing confirmed that Emergency Lighting works are required and non- Essential ignition sources tum off? In the past 12 months,has there been any instances of the LEL Detector activating either due to actual release or false alarm? Is there any other indication(stain,odor,damage to equipment,etc.)in the basement that hydrocarbons may or could be accumulating in the basement? +slued 12/272017 Page 9 of 10