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UNDERGROUND STORAGE TANK DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 2of 2) Vll. INSPECTION HISTORY Y h` Has each follow-up action of section III from the previous inspection been completed appropriately? .-"N Yach documentation verifying appropriate service to this report) ❑ VIII. ALARM HISTORY — _ - Attach a copy of the alarm history report/fog to this report. Y N NA 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 verifying appropriate service to this report.) iA ❑ 11 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 LX p 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 TA0252102 -ARROW- UNLEADED-WEST ❑ ❑ ❑ TA0252101 -ARROW- DSL- EAST ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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 TA0252102-ARROW-UNLEADED-10K ❑ ❑ ❑ TA0252101 -ARROW- DSL- 10K ❑ ❑ ❑ Is the fill pipe free of obstructions? TANK ID TA0252102-ARROW-UNLEADED-10K ❑ ❑ ❑ A02521 01 -ARROW- DSL- 1 OK ❑ ❑ ❑ the fill cap securely on the fill pipe? TANK ID TA0252102-ARROW-UNLEADED710K ❑ El ❑ TA0252101 -ARROW-DSL- 10K ❑ ❑ ❑ 7 - I Is the under-dispenser containment free of damage,water,debris,and hazardous substance? Under-dispenser Containment ID Y N JE01 Under-dispenser Containment ID Y N N East Dispenser Hose#1 -Diesel p ❑ ❑ ❑ East Dispenser Hose#2- Unleaded pa' ❑ ❑ ❑ ❑ West Dispenser Hose#3- Diesel ❑ ❑West Dispenser Hose#4- Unleaded ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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 _ Has the monitoring system certification been completed within to past 12 months? PERFORMED® 1101/24/20 Has the spill container testing been completed within the past 12 months? kM® ❑ 01/24/20 Has the overfill prevention equipment inspection been completed within the past 36 months? ® ❑ ❑ 10/12/18 Has the secondary containment testing been completed within the past 36 months? ® ❑ ❑ 12/14/17 Has the tank tightness testing been completed within required timeframes? ED] 11 Has the line tightness testing been completed within the required timeframes? ❑ ❑ Other required testina f maintenance was completed within r uired timeframe. (List test(maintenance items below. Test/Maintenance:Annual Leak Detector Test ® ❑ 01/24/20 Test/Maintenance:SB989 Seconds Containment Testing Due 12/14/2020 ® ❑ 12/14/17 Test/Maintenance:Overfill Prevention Inspection Due 10/12/21 ® ❑ 10/12/18 Test/Maintenance: ❑ ❑ Test/Maintenance: ❑ 13 Test/Maintenance: ❑ ❑ XI. FACILITY EMPLOYEE TRAINING Y N Have all individuals performing facility employee duties received the required facility employee training within the past 12 months? ® ❑ if 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