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14749 North Thornton Road PR0515788 <br /> December 20, 2021 Program: APSA <br /> PHOTO 4: 2020 annual ins ection incom lete not all tanks ins ectedAM <br /> . <br /> *_A <br /> STI SP001 Annual Inspection Checklist <br /> General inspection Information: <br /> Inspection Dale: Prior Inspection Date:1 z/ZQ 11 <br /> Retain until date: <br /> Inspector Name(print. <br /> �, If r�• Title: MDWI <br /> inspector's Signature: n ) <br /> Tanks)Inspected ID <br /> Regulatory facility name and ID number(if applicable) l 0 y <br /> cru CYL- d R u-to <br /> Inspection Guidance: <br /> e as <br /> as they are <br /> equivalent <br /> ➢ Folr1equlpmllent nottincluded in h sdSta d'ard Locally follow theemanufacturerr recommendled Inspect on/testing schedulesaand procedures.applicable). <br /> ➢ The periodic AST Inspection Is Intended for monitoring the external AST condition and its containment structure,This visual inspection does not require a Certified <br /> Inspector.It shall be performed by an owner's inspector per paragraph 4,1.2 o1'the standard, <br /> o Remove�o promptly <br /> liquid ater or regulated liquiproducts erred in the other contaminants secondary ad d'posed inment it property,Interstice,or spill container.Before discharge to the <br /> Y In order to comply wittheh EPA SPCC(Spill Prevention,Control end Countermeasure)rules,a facility should regularly test liquid level sensing devices to ensure proper <br /> operation(40 CFR 112.8(c)(8)(0). nr containment intQgrtY require evaluation by an engineer experienced in ASI'design,a Certified Inspector,ora tank <br /> Non-conforming items Imoorta_ nt to tanker-- <br /> manufacturer who will determine the corrective action.Note the non-conformance and corresponding corrective action in the comment sedan. <br /> Retain the completed checklists for at least 36 months. <br /> tel to the owner monthly-performed inspection checklists. <br /> ➢ Complete this checklist on an annual basis,supp <br /> Note: faby a change Paofoccurradto tile,Englneea knowledgeable InaSPCCtdevelo menft endhmplemontallonthe condition should be evaluated against the current n <br /> requirement <br /> --------�— STATUS. �COMMENTS/DATI____ <br /> ;CORRECTED <br /> ITEM <br /> Tank FoundationlSupporls <br /> EYes []NO1 Free of tank settlement or foundation washout? o DN/A —.— —— <br /> Concrete pad or ring wall free of eeacking and _. <br /> 2 spelling? <br /> �----- <br /> Page i of 4 <br /> Annual Checklist <br /> �`t <br /> - <br /> Lydia Baker, SR. REHS Page 4 of 5 <br />