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UNDERGROUND STORAGE TANK DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 2 of 2) VII , INSPECTION HISTORY Has each follow- up action of Section III from the previous inspection been completed appropriately? Y N Attach documentation verifying appropriate service to this report. ® ❑ VIII . ALARM HISTORY Attach a copy of the alarm history re ort/lo to this report. Y N NA Is the monitoring system powered on and in proper operating mode? X ❑ ❑ Has each leak detection alarm since the previous inspection been responded to appropriately? X ❑ ❑ Attach documentation verifiving a pronriate service to this report. Have all containment sumps that have had a leak detection alarm since the previous inspection been responded to by a ® ❑ ❑ qualified 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 ❑ ❑ ro 11 11 El ❑ El ❑ El El 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 X E)j Tank ID ❑ ❑ Tank ID ❑ ❑ TanklD ❑ ❑ Is the fill pipe free of obstructions? Tank ID 001 /Diesel/6 ,000 Gallons X 01 Tank ID ❑ LO Tank ID I ❑ I ❑ I Tank ID ❑ ❑ Is the fill cap securely on the fill pipe? Tank ID 001 /Diesel/6 ,000 Gallons MI ❑ Tank ID I Ell ❑ Tank ID ❑ I ❑ I TankID ❑ ❑ Is the under-dispenser containment free of damage , water , debris , and hazardous substance? Under- Dispenser Containment ID Y I N I NAI Under-Dispenser Containment ID Y N NA ❑ ❑ ❑ ❑ ❑ ❑ 1:11 ❑ I ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ I ❑ ❑ ❑ ❑ L1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 01 ❑ I ❑ Are all sensors in under-dispenser containment located to detect a leak at the earliest opportunity? ❑ ❑ X. TESTING AND MAINTENANCE Y N NA Date fast 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 ? X ❑ 08/02/ 18 Has the overfill prevention equipment inspection been completed within the past 36 months ? X ❑ 1 ❑ 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 ? ❑ ❑ X Other required testing I maintenance was completed within required timeframe . (List tesbmaintenance items below. ) Test / Maintenance : Cathodic Protection X ❑ 08/23 / 17 Test / Maintenance : ❑ ❑ Test / Maintenance : ❑ ❑ Test / Maintenance : El El Test / Maintenance : ❑ ❑ Test / Maintenance : El [EllXI . FACILITY EMPLOYEE TRAINING Y N Have all individuals performing facility employee duties received the required facility employee training within the past 12 months? ® ❑ the facility has more components than this form accommodates, additional copies of this page may be attached. Y = Yes, N = No, NA = NotApplicable, ID = Identification