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UNDERGROUND STORAGETANK FHas GNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 2 of z) VII . INSPECTION HISTORY h follow- up action of Section III from the previous inspection been completed appropriately? Y N Attach documentation verifying appropriate service to this report. ® I ❑ VIII . ALARM HISTORY Attach a copy of the alarm history report1log to this report. =responded NINA Is the monitoring system powered on and in proper operating mode?Has each leak detection alarm since the previous inspection been responded to appropriately?Attach documentation verifvin a pro late service to this report. Have all containment sumps that have had a leak detection alarmsince the previous inspection ❑ ❑ 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 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 Piping Sump ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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? Tank ID 001 /Diesel 6 , 000 Gallons ® 10 1 1 01 ❑ Tank ID ❑ ❑ Tank ID ❑ ❑ Is the fill pipe free of obstructions ? Tank ID 001 /Diesel 6 , 000 Gallons ® ❑ Tank ID ❑ ❑ Tank ID ❑ ❑ Tank ID ❑ ❑ Is the fill cap securely on the fill pipe ? Tank ID 001 / Diesel 6 ,000 Gallons ® ❑ Tank ID ❑ ❑ Tank ID ❑ ❑ Tank ID ❑ ❑ Is the under-dispenser containment free of damage , water , debris , and hazardous substance? Under-Dispenser Containment ID Y N NAI Under-Dispenser Containment ID Y N NA ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Are all sensors in under-dispenser containment located to detect a leak at the earliest opportunity? ❑ ❑ X . TESTING AND MAINTENANCE Y N NA Date Last Performed Has the monitoring system certification been completed within the past 12 months ? ® ❑ 08/02/ 18 Has the spill container testing been completed within the past 12 months? M ❑ 08/02 / 18 Has the overfill prevention equipment inspection been completed within the past 36 months ? M ❑ ❑ 08/02/ 18 Has the secondary containment testing been completed within the past 36 months ? ® ❑ ❑ 08/24/ 17 Has the tank tightness testing been completed within required timeframes? ❑ ❑ Has the line tightness testing been completed within the required timeframes ? ❑ ❑ Other required testing 1 maintenance was completed within required timeframe . (List test/maintenance items below. ) Test / Maintenance : cathodic ® ❑ 08i22t17 Test / Maintenance : ❑ ❑ Test 1 Maintenance : ❑ ❑ Test / Maintenance : ❑ ❑ Test / Maintenance : ❑ ❑ Test 1 Maintenance : ❑ ❑ XI . FACILITY EMPLOYEE TRAINING JY N Have all individuals performing facility employee duties received the required facility employee training within the past 12 months? ® ❑ I the facility has more components than this form accommodates, additional copies of this page may be attached. Y = Yes, N = No, NA = Not Applicable, ID = Identification