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,ore, y� by j 101roR� REN �� ; _. 't 't� R� ^ +�' AVO -� �/Q• 1416, 6e t Y GE TANK UNDERGROUND STORA (?�d,�� } GROUND STORAGE TANK OPE17 TOF VISUAL INSPECTION REPORz _ DESIGNATED UNDER Y N VII- INSPECTION HISTO d appropriately? ❑ usinspection been comp vio Has each follow-up action of Sectioon l��ato s rvica to this report• Attach documentation verifying apP p VIII. ALARM HISTORY ❑ ❑ Attach a co of the alarn` i histo — reporoog to this repo• ❑ ection been responded to appropriately? ❑ 0 Is the monitorin s stem owered on and reviou lisp cortin mode? Has each leak detection alarm since ti ate service to thls �• ❑ � ❑ Attach documontJtlo11 ver! In a Have all containment sumps that have had a leak detection alarm since the previous inspection been responded to y a H _-- ualified UST Service Technician ? List below In Section IX all containment sumps that have had a leak detection alarm since the previous inspection and have no been low requir responded to by qualified UST S rvl ce TO location nThe rocesulis of1l a vi ual ins ment sumps listed ection must be recorded n Section IX ction for mage, water, debris, hazardous substance and ro - — 1X, UNDERGROUND STORAGE TANK SYSTEM INSPECTION Is the containment sump damage , water, debris , and Nzardous substance ?Containment =1D N Containment Sum ID ❑❑❑❑Are all sensors in containment sumps inspected located to detector teak at the earliest opportunity? ❑ Is thes ill Tank ID container free ofdsmage, water, debris, and hazardous substance? t ' I E � Tank ID 1:1 ❑ :1Tank ID T2 : L3 ❑ Tank ID ❑ ❑ il Is the fill pipe tree of, obstructions? _ Tank ID I T t := Tank ID ❑ ❑ Tank 1D ITI . S t _ ❑ Tank ID ❑ 1 ❑ Is the fill cap securely onthe-fill pipe? Tank ID 1 i t * Ya I I -E `tank ID — ❑ ❑ Tank ID T7 : ; r n i ❑ Is the under-dispansst cantab7mrd free of , water, debris , and hazardous substance ? Under-Dispenser Contah went In Y ltd NAI Under= Dispenser Containment ID Y N N . Dis enser 1 /2 U Dispenser 3/4 ❑ Dispenser 5/6 D D Dispenser 7/ 8 ❑ ❑ Dis enser 9/ 10 ❑ ❑ Dis enser 11 / 12 ❑ El I] ❑ ❑ ❑ ❑ ❑ ❑ ❑ _ ❑ ❑ ❑ Are all sensors in under-d+spEraartosit0 El abWrent located tomeieata leak at the earliest opportunity? IE511I'tiG AND MAINTENANCE Y N hi , i I Date Last Has the monitoring syslenr ceriif+cation been completed within the Performed past 12 months ? ❑ Has the spill container testing bean =mpleted within the past 12 months? tHastHas the overfill prevention Equipment inspection been completed within the past 36 months ? ❑ ❑ he econdary containnnent testingbeen completed within the past 36 months? ❑ 1=Hasank tightness ng been completed within ❑ ❑ �9 EXtr� P � ne tightness testis fora timeframes? ❑ ❑ ❑ El 9 _ vdthin the eWred faeframe ; ? Other required testing / mainterrattce v_ ras,cornpleted yoitiv � nquired timeframe . (List test/maintenance items bel o w. El PPerfOrn" aintenance : intenance — �- — -�, ❑ ❑ Maintenance :_ - --� - ❑ ❑ intenance : -i ----- --_ — ❑ ❑ - ---- interianre : ❑ ❑ intenance: _ -- ❑ ❑ — - - - __ XJ* FACILITY EMPLOYEE TRAINING ❑ ❑ — HidwJs —LKEN perfarmiN. faciI4 employee duties received the facility e�-niployee training within the past 12 months ? ❑ tes, additlonst copies of thj age maybe attached.