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M m < -a O = N � �' v I 0) 0: N O O .. N � O O y s o N r w �>=SfG U pERGROUNp IYAtEt?UNDERGROUND STORAGE TANK OPE Q- � O BATOR V ORT(Page z of zJ 7 Has ea Irll• INSPECTI ISUAL INSPECTION REP L o-na�yf+Owfg �n or on it+so�Mme arevious inspecvo^tin�m HISTORY Y N (D N _ ! rvirg to this ra It. P tea aPProprrapahR ❑ (3 >? CD In At�c copy of the ararm hist°ryrepowo �Vlfl. ALARM HISTORY rA N Aral a � T1 monitoring System Anwered O^and fn g thrg rkti 1 I Has eat al.leak dl ion afarm since the Proper-Peml mode? Y N NA Q�. 5 /Ani' utAentaf/pn veriryr'rrg aPPropnal aN'nsPec[ran been respond 0 ❑ ❑ O Nave all containment sum s, M. to a (D rce to mp°vt) service lath^- P that have Aad a leak d PPfOPnatety? ® ❑ ❑ N a List below r", election alarm since the G I,secSon l,,all contaln Previous ins �_ O responded M 6 Ment su pection hazardous su Y a 4�rr�ed UST servi n7ps that hay@ had 'b` ^m5Ponded to by a qualified UST 0 ❑ ❑ O - O bstahce,and t�hnlclan. Contain a teak detectr°n ora (D IX.sensorlorahon_ me u ofHum�listed grace the prevtvus in - rs the co U ERGROUNU ST a visual in meum a vrsoal insper:don Ill damage,°waterer,debris, � O Q rrtamment sump free of damage,water,debris,and h ORAGE recortledln season Ix. -O W ConfainmentSumplD azardou TANK SYSTEM INSPECTION s sub O stahoe? n O Y N — n ❑ ❑ Containment Sump Ip Y N o3 Q 0 ❑ C] ❑ ❑ m p Are all sensors in ❑ ❑ ❑ ❑ 0 0 (7 oorttairmtentsum1151 ❑ ❑ ❑ ❑ 0 O D Is the spill cotttaln�fine of damage,wafer n sPected located to detect a leak at the earliest o 87 debris,and hazardous substa PPonull ❑ ❑ T TANK ID l ® ❑ � N 9i 0 ❑ DSL m � is the fill Pipe free of CL obstruttions? � ❑ � ❑ 7 TANK ID 87 ❑ ❑ O O 91 2. m } 0 El DSL fs the fill Ca I 1 p securely on the fill pipe? 0 ❑ ® El �• N TANK 1D $7 ❑ ❑ (Q O A 91 ® ❑ DSL (n 0 Is the - undef�isP°t> rcontainment ® ❑ ® ❑ to n Under�is free of damage,water,debris,and h CD 1/2 unser Containment ID azardous substance? ❑ ❑ Y N N m 3/4 ® ❑ ❑ Unde►-dispenser Containment ID O — Y N N 0 El 0Ej❑ ❑ ❑ ❑ v em rit ❑EJ El ❑ ❑ 00 Are all sensors in under-dispenser containment located to d�EJ El p t the earliest o ❑ _ ❑ ❑ ❑ Q (D PPortunily7 ❑ ❑ ❑ rn - Has the monitoring system certification X. TESTING AND ® ❑ ui Has the spill container testin bPeen completed thin the past 12 munthnsAINTENANCE ❑ N 9 been Completed within the past 12 Y N NA DATE LAST n t) Has the overf�il prevention months? PERFORMED O N equipment ins e ® ❑ 3 O Has the s P ctlon been completed within the past 36 5-10-20 N econdarycontainment testing been Completed within the months? ® ❑ Has the tank tightness testing been completed within r Past 3fi 5-10-20 O months? ® ❑ CD Has the line tightness testin equired timeframes? © 4-11-19 _- O• Other g been completed within the r ® ❑ ❑ 7/19118 m �• aired testin /mafntenart equired timefrarnes� ❑ LI! � ce was com feted within aired time ❑ ❑ Test/Maintenance: frame. D List fesF/maintenartceltems tleiOw. ❑ ❑ ❑ tQ to Test/Maintenance: G to Test/Maintenance: CDD Test/Maintenance: ® ❑ 4`11-19 In 3 ❑ ❑ 0- Test/Maintenance: ❑ 0 N C7 ;p Test/Maintenance: ❑ ❑ C m ❑ 3 5, o X1. FACILITY EMPLOYEE T ❑ ❑ 3 v D a Have all individuals performing facility employee duties received the RAINING ❑ Q � c required facility MPloyee training within the pad v i2 v U) � months? Y N W = o- n u, cn o N C) N NON O W CD o 04/27/20212:07 , ' lv m