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UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 2 of 2 <br /> VII . INSPECTION HISTORY Y N <br /> Has each follow-up action of section III from the previous inspection been completed appropriately? X <br /> Attach documentation verifying appropriate service to this report.) <br /> VIII . ALARM HISTORY <br /> Attach a copy of the alarm histoU reporUlonto this report. <br /> Is the monitoring system powered on and in proper operating mode? X <br /> Has each leak detection alarm since the previous inspection been responded to appropriately? <br /> (Attach documentation verifvina aoorooriate service to this recort.) X <br /> Have all containment sumps, that have had a leak detection alarm since the previous inspection, been responded to by a X <br /> qualified UST service technician? <br /> 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 <br /> by a qualified UST service technician . Containment sumps listed below require a visual inspection for damage , water, debris, hazardous substance, <br /> and proper sensor location . The results of the visual inspection must be recorded in section IX. <br /> IX. UNDERGROUND STORAGE TANK SYSTEM INSPECTION <br /> Is the containment sump free of damage, water, debris, and hazardous substance? <br /> Containment Sump ID Y N Containment Sump ID Y N <br /> N/A X N/A X <br /> N/A X N/A X <br /> N/A X <br /> N/A X <br /> Are all sensors in containment sumps inspected located to detect a leak at the earliest opportunity? IVIA X M �` <br /> Is the spill container free of damage, water, debris and hazardous substance? <br /> TANK ID Tank-87 X <br /> Tank-91 X <br /> Is the fill pipe free of obstructions? <br /> Tank-87 X <br /> TANK ID Tank-91 X <br /> Is the fill cap securely on the fill pipe? <br /> Tank-87 X <br /> TANK ID Tank-91 X <br /> Is the under4soenser containment free of damage , water. debris, and hazardous substance? <br /> Under-dispenser Containment ID Y N N/A Under-dispenser Containment ID Y N N/A <br /> Dispenser-112 X <br /> Dispenser-3/4 X <br /> Dispenser-5/6 X <br /> Dispenser-7l8 X <br /> Ll <br /> Are all sensors in underAispenser containment located to detect a leak at the earliest opportunity? X <br /> X. TESTING AND MAINTENANCE Y N N/A EDATE <br /> R O MS D <br /> Has the monitoring system certification been completed within the past 12 months? X 9/20/18 <br /> Has the spill container testing been completed within the past 12 months? X 9/20/18 <br /> Has the overfill prevention equipment inspection been completed within the past 36 months? X N/A <br /> Has the secondary containment testing been completed within the past 36 months? X N/A <br /> Has the tank tightness testing been completed within required timeframes? x N/A <br /> Has the line tightness testing been completed within the required timeframes? X N/A <br /> Other required testing / maintenance was completed within required timeframe. (List test/maintenance items below.) <br /> Test / Maintenance: X N/A <br /> Test / Maintenance: x NIA <br /> Test / Maintenance: X N/A <br /> Test / Maintenance: X N/A <br /> Test / Maintenance: X NIA <br /> XI . FACILITY EMPLOYEE TRAINING Y N <br /> Have all individuals performing facility employee duties received the required facility employee training within the past 12 months? X <br />