HomeMy WebLinkAbout18370 000062 101 01-07-2020 REGINP SLA COMPLIANCE INSPECTION 55019.01 FACILITY I.D.NUMBER: 2 2 '44 Z - 10 I - 01 ( a4C_ REGINP ))a,Jr
A®EM
NOTICE OF UNDERGROUND STORAGE TANK UST COMPLIANCE INSPECTION
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ecamroellrtwgsw n the store eel Wakdau0sfenrea and emnY the enlefMb xadrecords.
3354-15.41 EnWendlna ecfian of Feci4Yiea.Myw'mexareperetva/art undargmund Aorepe bnkaheY upon request o/a dulyaufFonzedrepresenlaRve oflhe 0epedm. pe,mXtM1a npnaenfelrvebanbr,
&C1'nYwHdB ' eNOUXd wryw¢enYnM /Wntl9Ma e2nkb boafedrace
ace ifha2 nRRve to ms ecllaLilbsantleu ns ection from:
Owner andsam m
Routine Coro Wnfxt I 'on Priori Ins ection ❑Follow Up Inspection from:
Owner Name $ 12aaol,5 L'LG #01 USTS I I
MailingAddress O x Facil' Name Nt 5 P b .✓
C' t C 2ooK State , L 5liic�4 StreetAddress L 7S W
Owner Email Address I Count of CRWNearest inlL
Submit Desi noted Notifications
❑Suspected Permanent CTemporery phew installation []Trensfer of []NotMcaton Other.
Release(forth 480) closure(forth 41 2) closure(forn 3f0) or upgrade(form 423) ownership(form 469) (form 279)
Submit Designated Regulatoy Fees
UST regulatory fee payment due for: []Current fiscal year ❑Prior fiscal years,specify:
Submit Designated Delinquent Test Reports
[]Annual line lightness test (0.1 GPH)(torn 477) []Annual test of automatic line leak detector(form 551)
[]Annual SIR 30 day results stanmary(form 326) ❑3 year Catchment basin(spill bucket)test(forth 20)
03 year UST hmpressed current cathodic protection test,(form 332) year containment sump integrity teat(forth 557)
C3 year Piping impressed current cathodic protection lest(form 332) nmual probes and sensors test(form 560)
03 r .Waniccathodb edion test form 545 Other:
Submit Most Recent Design ted Additional Test Data
30 day ATG 0.2 gph tei pdmout 030 day tank interstitial sensor printout
30 day CSLD test prntotrt_ 030 day manual inte(stitial monitoring log(forth 406)
day SIR repot log(to.326) []Electronic line leak detector 3.0 gph test pdomut
nual release detection equipment testing log(form 561) []Monthly electronic line leak detector 0.2 gph test printout
030 day containment sump sensor printout []Annual electronic line leak detector 0.1 gph test prompt
030 day manual tank Stpullini form 563 []Other:
Submit Designated Operation and Maintenance Inspection Results
[]60 day impressed Current CP Inspection Log(form 400) Annual walkthrough Inspection log(form 19)
03 ar overfill prevention hw ection form 559 []Monthly walkthrough inspection to form 551
Opened in and Maintenance Needing Immediate Action
Containment Sumo. Containment Sumo Equipment Operator Training
[]Empty water&properly maintain sumps) []Properly position sump seraphs) - ❑Submit A-B operator training retard
[]Empty fuel w fuel/water mix,chances of properly& []Sump sensor must shut of sub pump ❑Submit C operator training record
property maintain sump(s) []Clear fuel alarm from sump sensors) CompatibdilN
ElRepair sumps adlor sump equipment as necessary []Replace missing line leak detectchs) ❑Suhmm missing compatibility logs
to prevent liquid from entering sumps []Replace deteriorated flexible piping Temoowrif Closed Tanks
Tank Cathodic Protection Rectifier Spill Prevention Equipment []Pedom leak detection
CNo amps or volts-restore power or fix meter []Remove fuel/water-dispose of properly []Monitor corrosion protection every 60 days
CAm reading too low-repairsystem&retest ❑Re airtlama etls ill catchment basins []Remove remainin contents to t inch or less
Inspector Comments:
Submit any requested information to the attention of the inspector at the address indicated below,fax to the inspector's attention,
or a-mail tq t�n/ss//p or a : E-mail Addr�4t.p, ®adam.sabama.gov
ADEM OIFW 07fdaflons' and ADEM[]Blmxngham Field Office ADEM[]Mo ile Fled Office ADEM[]Decefur Field Office
D7Nsion Omce,P.O.Boz 3 1483 770 Vuscan Road
2204 Pedrtrefer Rd. 2715 Sandlin Road,S.W.
Montgomery,Alabama 3(130.1483 Blmdngbam,Alabama 352094702 Mobi Alabama 36615-1131 DecaNr,Alabama 35603-1333
Phone/Fax# 334 ?i Phone/F8X# lol=2 Fax# 51 PhmnmFax# 256
Coro Dance Ins on Results
o Action Required-Thank youfor yourcontinuin efforts to comply with the ADEM UST rsgitLa8ons.
Adddlonal Information Requested ❑ Delinquent Information Required ❑Immediate Action Required within 24 hours
t requested informatioNconfirmation to ADEM within 7 days. Failure to submit the requested information could result in enforcement actions and
penalties,as well as this facility being prohibited from delivery by the Department through placement on theDepartment's Deli Prohibition Website.
NOTE: THE ABOVE FACILITY WAS INSPECTED TO DETERMINE COMPLIANCE WITH ADEM ADMINISTRATIVE CODE RULE 3356-15. THE STATUS
OF COMPLIANCE IS INDICATED ABOVE.
Receipt of 'ADEM US Compliance Inspection"is hereby acknowledged by the facility owner or representative.
B other the ompetir recelves this notice,It should imenecilabely be forwarded to the owner,of the USTs.
Si nature of O , -or Re Owner or Representative a Printed Name D ADEM A /'7
Si f s is tic r'. Na Dale — ( —
ADEM F M Zile mi 7/72 m2(revised 3118) TOP COPY- TTOM COPi ❑Supple a ad
Owner Name: S & S EAGLES, LLC Page 1
Owner Type : P P.O. BOX 792 2�1
MILLBROOK AL 36054
Owner Phone: 3344910503 Fax Phone: 3344602001 OPERATOR TRAINING:
Owner Contact Name: SAM SWAMMIE YES
Owner Contact Phone: 7066816981
Email (verified from web): Email (OLD unverified): auroswamy@gmail.com
I Number of Sites A ' The Fiscal Account information,is provided Owner Fee Information FY' 2019' 2018,
GSA ID to aid in the Inspection process only. It:
reflects the�rlets account status as of the Billed Amount 330 "330
Bad Address printed.date and is subject to change on a'
daily basis based on payments made and Paid Amount 330 - 330 .j
No BIII, number of tanks in service during the year:- i
SITE DATA---------------------------------------Date of last walk Thru Cannot locate Site:
Site Name: ONE STOP 72 LIBERTY STORE Abandoned Site:
1175 WEST SOUTH BLVD. Adjacent to residence
MONTGOMERY AL 36105 Within 300 feet of residence:
Site Contact Name: SAM SWAMMIE Located within Indian Lands:
Site Contact Phone: 7066816981 Located within Wellhead Protection Area:
Email (verified from web):. Email(OLD unverified)
............................GPS Data.....................................................
Location: .Decimal Deg Degrees Minutes Seconds ..............Verified..............
Latitude: 32.327280 32 19 38.208000 Code;
Longitude: -86.339620 -86 20 22.632000 Date:
Stagel'facility number:. 209-G-139
Number ofUSTs NumberofASTs:,. ` 0
11
Currently '>e ' ActiveASTs ` 0'
Y 6 � r 1
li
i Temporarily Closed 5
'3 YR Insp tanks NOTE Sde has no tanks wdh compabbdrty
Permanently Closed}' 0 np. ,f5emonstration needed
E_S.v`t' (�w5 4 MpTMf �1�MF.
Retired. r, ^ +,'� U
Contested ln edi.
Inspector Comments:
Facility 1. k 1 000062 ADEM LIST INSPECTION - 1 1
Owner Name: S&S EAGLES,LLC Page 2
Site Name: ONE STOP 72 LIBERTY STORE
1,Description of underground storage tanks
A"Torok status(Mark all that apply) TANK ID NO 0106741.1011 IU1Ub7bUUZ 010,676 U 03 010677 U 04. 010678 U 05'•'
I.Currently in Use
• 2.Temporarily Closed x x x x x
a.Estimated Sate last used 5117/2010 5/1712010 5117/2010 6111/2007 5117=10
b.Estimated quantity of substance remaining
6.Contested Ownership
Date Owner contested awnership of tank _
Cannot Locate Tank _
C.Tank History
p9'�:'h�A;Y
1.Data I-,bled 1/1/1981 iM/1981 1/i/1981 _111/1981 11111981
D.Tank Estimated Total Capacity(gallons) 10000 10000 10000 10000 10000
L Number cf compartments if compartmented tank 1 1 1 1 1
2. Number of manifolded tanks if manifolded 0 ! 0 0 0 0
E Substance Currently Stored (Mark all that apply)
I.Petroleum
a.Unleaded Gasoline
b.Mid GradeGasoline
c.Premium Gasoline
d.Diesel
e,Kerosene
f.Aviafion fuel(JP4),etc.
Usetl OII
In.Virgin Oil
I.E-85
.Biodiesel
1.Other,Pleases ecity
2.Hazardous Substance
a.Please indicate Name of Principal CERCLA Substance or
b.Chemical Abstract Service(CAS) No.
F:Fdnk Usage(Mark all that applYl• _ _ _= ^. _ • - ' ��
1.Emerge_ncy Power Generator(Pad IV not required) _
2.Retail x x x x x
3.Bulk Facility
A.Industrial
5.Local Government
6.State/Federal Government
7.Farm
B.Heating Oil Notification not Required)
, _.u...., -.etc 's3� •y..
ofmlpllonTor this FY as of date printed Fees billed 30 30 30.
30 30
Tank C mentaW Tank 1D674 Tank Commema for Tank 10675
Tank Commands for Tank 1061 Tank Comm•Ms for Tank 10677
rank Commarda for Tank teals 010674 E COMPATIBILITY-REQUIRED: n`�'E_COMPATIBILITY_VERIFII
010676 E_COMPATIBILITY_REWIRED: u E_COMPATIBILITY_VERIFIED
010676 E_OOMPATIBIUTY_REQUIRED: ®E COMPATIBILITY_VERIFIED®
010977 E_COMPATIBILITY-REQUIRED: E_COMPATIBILITY_VERIFIED
efeen E_COMPATIBILITY_REQUIRED: ❑B_COMPATIBILITY VERIFIED
Owner Name: S&S EAGLES, LLC Page 3
Site Name: ONE STOP 72 LIBERTY STORE
Ii.Corrosion Protection
..
G.Tank Construction Material(Mark all that `pl ): ` ,010674 U(11.0104l 02. '010676 U 03 010677 f1414 010678 U.05
- Single Wall
Double Wall
1.Steel
2.Fiberglass Reinforced Plastic X X X X X
3.Fiberglass Coated Steel
4.Other,Please Specify
St-70hktd7okan Protection Mark all that aP ly)is
1.Galvanic Cathodic Protection
2.Impressed Current Cathodic Protection
Date cathodic protection installed
3 YR CP REVIEW
3 YR CP TEST DATE
3.Interior Lining e. .,epoxy resins
Date interior lining installed
INTERIOR LINING INSPECTION REVIEW
INTERIOR LINING INSPECTION DATE
4.Other,None or Painted, Please Specify
1.Piping Material Of Construction(Mark all that apply?
Single Wall
Double Wall
Installation Date
1.Steel
2.Fiberglass Reinforced Plastic X X X X X
3.Flexible
Manufacturer
4.Other material or piping information .-
9:Steel Piping Corrors Proteciibrn(Mark all that apply)
-
1.Im rl Current Cathodic Protection
2.Galvanic Cathodic Protection e.g.sacroficial anodel
3.Isolated or Above Ground
Date protection Installed
3 YR CP REVIEW
3 YR CP TEST DATE
4.None or N/A X X X X X
5.Other,Please specify 2
""Over"'
.TanRSpillPfeVan{IonE ui mentIMark allthgt.appl
1.Catchment Basin X X X X X
Test Date
Reviewed
2,Other,Please specify
3.Not required
C Tank OverfillhPreventioh uiPmeritiMark all ihat'apply)
-''7�77 - ^="-`v` �'
1.Flow Restrictor at 90%full(e. .,ball float vent valve)
2.Automatic Shutoff Device at 95%full(e.g.flapper X X X X X
valve)
3.High Level ABm at 90%full must alert fuel deliverer
4.Other,Please speci
comments:
' Facility 1.
D. 1 000062 ADEMP - 11
Page 4
DetectionIV.Release
M.Tank Methods of Release Detection(Mark all Thal apply). 0106741.1 01 010fi75+U 02(
16 7/121201fi 010676 U'03. 010677 U 04 010678 U 05
1.Automatic tank gauge _
2.Continuous Automatic tank ua e
_ Probe Test Date
Sensor Test Dale -
Console Test Dale
IM Sensor Test Dale Tig
ht ht testing every sfor only 10 yrs w/inventory control
Date of Tank Tightness Test 7112I20t6 7/12120 7/1212016 7/12@01fi
4.Tank tighness testing once every 5 years far only 10
years with manual tank gauging(inly tanks 551-2000 gal.(
5.Interstitial monitoring
Monthly log date
Type of IM method for above
6.Vapor moniforin
Vapor Approval Date
7.Groundwater monitoring
Groundwater Date
8.Manual tank gauging(only tanks 10D0 gal.or less(
9.Statistical Inventory Reconciliation(SIR) X R % % X
SIR Annual Report Date(Year only) 2003 2003 2003 2003 2003
11.Other,Please specify
N.Pressurnetl Piping Method of Release EjtectlonIII "M
Containment Sum
Sump Test Date
Annual Inspection Date 11111901 1/1/1901 1/1/1901 1/1/1901. 11111901
1.GROUP Mark ofieofthe following) `''r,"
a,Automatic Flow Restriator)MLLD)
Annual Test Date 9/12/2008 5/29/2007 2 2007 911=008
b.Automatic shutoff device(ELLD) _
ELLD Test Date
c.Continuous Alarm System _
Sump Sensor Test Date
d.Sump Sensor Relayed
Sump sensor relayed Test Date
d.Other,Please Specify MANIFOLDED MANIFOLDED
2.GROUP It (Mork oheof the followirig(.
6.Annual Line Testing
Line Test Date 6/29/2007 WM2007 6/26/2007- 6/2612007
b.Automatic electronic line leak defector
c.Vapor Monitoring (SAME AS FOR TANKS
d.Groundwater Monitoring(SAME AS FOR TANKS
e.Statistical Inventory Reconciliation(SIR) x % % X X
f.lntersfitial monitoring
Monthly Log Date
Type of IM method above
.Other,Please Specify
O.Suction Piping Melhod9f.Release Detection(Mak oi)e) ` 17--77
1.Line tightness testing every 3 years
Date of Line Test
2. Interstitial monitoring
Type of IM method above
3.Vapor Monitoring SAME AS FOR TANKS)
4.Groundwater Monitoring )SAME AS FOR TANKS
5.Safe Suction
6.Statistical Inventory Reconciliation SIR
7.Other;Please Specify
P.GroVIty Piping No leakdefectlonr 0ired 's •-'-
V.UIC(If yes to the next civestion,send copy of this report to UST/UST Compliance Section Chief.)
Are there floor drains in an automobile repair shop that discharge to field lines at this facility? YES NO
Facility.1. 6 6 0660. a a - k a
Owner Name: S&S EAGLES,LLC Page 5
Site Name: ONE STOP 72 LIBERTY STORE
a-
Tankstatus(ti all h4cl appl ) ;. -TANK ID NO: 01067E U 06 1210680 U 07 . 010681 U 08 010682 U 09 110106831.1110
1.Currently in Use X X X X X
2.Temporarily Closed
a.Estimated date last used
b.Estimated quantity of substance remaining '
6,Contested Ownership _
Date Owner contested ownership of tank _
Cannot Locate Tank
C.Tank History
I.Date Installed IMI1981 I VIM981 1/1/1981 1/1/1981 1/1119al
D.Tank Estimated Total Capacity(gallons) 10000 10000 10000 10000 10000
1.Number of compartments if compartmented tank 1 1 1 1 1
2. Number of -anifolded tanks if manifolded 0 0 0 0 0
E.Vto
Substance Currently Stored(Mark all that apply)
Petroleum.Unleaded Gasoline
Mid-Grad Gasoline _X
c.Premium Gasoline
d.Dlesel
e.Kerosene
1.Aviation Fuel(JP4),etc.
g.Used Oil
h.Virgin Oil
L E-85
J.Blodiesel
1.Other,Please specify PPEIPE2
HazardousSubstancee
a.Please indicate Name of Principal CERCLA Substanc or
b.Chemical Abstract Service (CAS] No.F,Tork Usage(Mork all that aPPlYII.Emer ency Power Generator(Part IV not required)
2.Retail % X X X
3.Bulk Facility
4.IndusMal
5.Local Government
6.State/Federal Government
7.Farm
8.Heafing Oil tNotif!cation not Required)
pee'Iht`f "'�0'a''p iar this FY as of catert5r1i Fees tilled 30 !30 30Fees paitl 30 30 30
Tank comments for Tank 10679 Tank Comments for Tank 10680
Tank CommxOs for Tank 10681 Tank Comments for Tank 10682
rank Canna ab for Tank 10683 010679 E-COMPATIBIUTY REWIRED: Q E_COMPATIBILITY VERIFIED
010680 ECOMPATIMUTY-REWIRED: E_COMPATIBILITY_VERIFIEDH
010681 E_COMPATIBILITY_REOUIRED: E_COMPATIBILITY_VERIFIED
010682 E-COMPATIBILITI'_REWIRED: ®E_COMPATIBILITY_VERIFIED®
0'10685 E_COMPATIBILITY REWIRED: E_00IAPATIBILIT7'_VERIFIED0
Facility 1. • 1 000062 ADEM LIST INSPECTIONe 1 1
Owner Name: S&S EAGLES,LLC Page
SAe Name: ONE STOP 72 LIBERTY STORE
I'.Corrosion Protection
G.TankGbnshV on f+taYeTaL"MWL fiIftYiatappl'y( :'.I'.,r. 0706781106 010680�U07 ':Of 681.1106"010682009 ';.010803U101
Single Wall
Double Wall
1.Steel
2.Fiberglass Reinforced Plastic X X X X X
3.Fiberglass Cooled Steel
4.Other, Please Specify
N°Steel Yank Corrosion Protection(Mark all that apply) _
I.Galvanic Cathodic Protection
2.Impressed Current Cathodic Protection
Dote cathodic protection Installed
3 YR CP REVIEW
3 YR CP TEST DATE
3.Interior Lining e. .,epoxy resins
Date interior lining Installed
INTERIOR LINING INSPECTION REVIEW
INTERIOR LINING INSPECTION DATE
A.Other,None or Painted,Please Specify
L.P1pIn_QMateroI Of Construction(Mark all that apply > "
Single Wall _
Double Wall
Installation Date
1.Steel
2.Fiberglass Reinforced Plastic X X X X X
3.Flexible
Manufacturer
A.Other material or piping Information _
J.stQ Piping.corrosion.Protection(Mar,all that apply) _
1.Im rased Current Cathodic Protection _
2.Galvanic Cathodic Protection e. .sacro0cial anode _
3.Isolated or Above Ground
Date protection Installed
3 YR CP REVIEW
3 YR CP TEST DATE
4.None or N/A X X X X X
5.Other,Please specify
Ill.. S 1110verfil Protection
' 5yill Prevention Equlpnidnt(Mark all that ppPly
1.Catchment Basin X X X % X
Test Date 112112019 11212019 11/2612019 11/202019 11/26/2019
Reviewed P P P
2.Other, Please specify
3.Not required
L:Tank 0wxfiIllPrevention Equipment (Mark all that'apply)
I. Flow Restrictor of 90%full(e.g.,boll float vent valve
2.Automatic Shutoff Device at 95%full(e.g.flapper X X X X X
valve)
3. a h Leve1 Alnn at 90%full must alert fuel deliverer
4.Other,Please specify
Comments:
Facility 1. D. 22442� a 0100. k • — 1 k
Page 7
Detection'IV.Release
M.Tank Methods of Release.Detection(Mark all that a p p yj 010679 U.as 070680U 07', 'U10681'U Us -`.'ui ubuz U 09 R711=016
1.Automatic tank gauge
2,Continuous Automatic tank sludge
Probe Test Date
SensorTest DaleConsoleTestDateIM Sensor Test Date
3.Tight testin every 5 yrs for only l0 yrs w/inventory control
Date of Tank Tightness Test 7/12/2016 7/12/20171 7112/201 77/1=0116
4.Tank tighness testing once every 5 years for only 10
years with manual tank gauging(Inly tanks 551-2000 gal.)
5.Interstitial monitoring
Monthly log date
Type of IM method for above
6.Vapor monitoring
Vapor Approval Date
7.Groundwater monitoring
Groundwater Date
6.Manual lank gauging(only tanks 1000 gal.or less)
9.Statistical Inventory Reconciliation(SIR)
SIR Annual Re od Date(Year only) 2003 2003 2003 2003 2003
11.Other,Please specify
N-Pressurized Piping MelhoQ of ReleaseDetectidn. .(At led
st one ite entorked)
Containment Sum
Sump Test Dote
Annual Inspection Date 1/1/1901 1/1/1901 11111901 1N/1901 1/1/1901
1.:GROUP 1 -Mark oneof}he followirig�. '
a.Automatic Flow Redrictor(MLLD) _
Annual Test Dote 11121%2019 11/21I2019 11/21/2019 N/21I2019 11/21/2019
b.Automatic shutoff device ELLDJ _
ELLD Ted Dale
c.Continuous Alarm System
Sump Senses Test Date
d.Sump Sensor Relayed
Sump sensor relayed Test Date
d.Other,Please Specify
2.GROUP IIIMark one 54 the'follov$ing r E11121T/2019
a.Annual Line Testing X X A X
Line Test Date 11/2112019 1112112019 11/21/2019 11/21/2019
b.Automatic electronic line leak detector
c.Vapor Monitoring (SAME AS FOR TANKS(
d.Groundwater Monitoring(SAME AS FOR TANKS)
a.Statistical Inventory Reconcifation(SIR)
f.Interstitial monitoring
Monthly Log Date
Type of IM method above
.Other,Please 5 eaif
O:Suction Piping Method of Release Detection(M� )Ye
1.Line tightness testing every 3 years
Date of Line Test
2. interstitial monitoring
Type of IM method above
3.Vapor Monitonn (SAME AS FOR TANKS
4.Groundwater Monitoring (SAME AS FOR TANKS
5.Safe Suction
6.Statistical Inventory Reconciliation(SIR)
7.Other,Ptease Specify _
P:GY vl `PI in No leak detectionr�mretl(_ '
.11l"C If.'es to the next question,send copy of this rep to UST/UST Compliance Section Chief.)
Are there Floor drains in an automobile repair shop that discharge to field lines at this facility? YES NO
00006 2 ADEM UST INSPECTIONf
Owner Name: S&SEAGLES,LLC Page
Site Name: ONE STOP 72 LIBERTY STORE
tl�imdiehgTiYuncl
'Tank Status (Mark all that apply) TANK ID NO: 010684 U 11
I.Currently in Use x
" 2.Temporarily Closed
a.Estimated Sate last used
b.Estimated quantity of substance remaining
b.Contested Ownership
Date Owner contested ownership of tank
Cannot Locate Tank
C.Tank History
I.Date Installed 1/1/1981
D,Tank Estimated Total Capacity(gallons) t0000
I.Number of compartments if compartmented tank 1
2.Number of monifolded tanks if manifolded 0
F.Substance Currently Stored(Mark all that apply(
1.Petroleum
a. Unleaded Gasoline _
b.Mid-Grade Gasoline
c.Premium Gasoline
d.Diesel.
e.Kerosene
f.Aviation Fuel JP4),etc.)
g.Used Oil
In.Virgin Of
I.E-85
J.Biodiesel
(.Other,Please specify
2.Haicandous Substance
a. Please indicate Name of Principal CERCIA Substance or
b.Chemical Abstract SerVCe (CA51 NO.
P;Tank Usage (Mark all that apply( -
I Fmergency Power Generator(Part IV not required)
-2. Retail -- x - -
3. Balk Facility
,T ndistrial
5.Local Government
6.State/Federal Government
7.Form
B.Heating Oil (Notification not Required(
Fee information for this FY as of date printed: Fees billed _
Fees paid
Tank Comments for Tank 10684
01084 E_00MPATIBILITY_REWIRED: E]E-COMPATIBILITY_VERIi
Facility 1. D. 22442 - r 000062 ADEM UST INSPECTION - 11612020
Owner Name: S&S EAGLES,LLC Page 9
Site Name: ONE STOP 72 LIBERTY STORE
11.Corrosion Protection
Tank Construction Material 'Mark all that apply) 010684 U 11
Single Wall
Double Wall
I.Steel
2.Fiberglass Reinforced Plastic X
3.Fiberglass Coated Steel
4.Other,Please Specify _
H.Steel Tank Corrosion Protection (Mark all that apply) - T -
1.Galvanic Cathodic Protection
2.Impressed Current Cathodic Protection
Date cathodic protection installed
3 YR CP REVIEW
3 YR CP TEST DATE
3.Interior Lining(e.g.,epoxy resins
Date interior lining installed
INTERIOR LINING INSPECTION REVIEW
INTERIOR LINING INSPECTION DATE
4.Other,None or Painted,Please Specify
L:Piping.Material Of Construction (Mark all that'apply)_
Single Wall
Double Wall
Installation Date
1.Steel
2.Flberglasrs Reinfaced Plastic X
3.Flexible
Manufacturer
4.Other moierial or piping information
J.Steel Piping Corrosion Protection'(Mark all that apply)
1.Impressed Current Cathodic Protection _
2.Galvanic Cathodic Protection leg.soaoficial anode) _
3.Isolated a Above Ground _.. .
Date protection installed
3 YR CP REVIEW
3 YR CP TEST DATE
4.None or N/A X
5.Other,Please specify
k TanWSP Prevention •luipment,(Mark all that,a
1.Catchment Basin X
Test Date 11/21/2019
Reviewed P
2.Other,Please specify
3.Not required
L.Tank OverfillPrevyn/fatT Wmenf' Il tha.d ' ""° "'.`4 i .., -: . .!e a.+x- : •i:°-KA'. �'• £:
r.
1.Flow Restricta at 90%full e.g-ball float vent valve
2.Automatic Shutoff Device a195%full(e.g.flapper X
valve)
3.Hi h Level Alrm at 90%full must glen fuel deliverer)
4.Other,Pleasespecify
Comments:
t D00062 ADEM UST INSPECTION CHECKLIST Printed 116/2020
Page 10
Detection1111.Release
M,Tank Methods of Release Detection(Mark all that apply) ' 01068411'11 {, -
1.Automatic tank gauge
2.Continuous Automatic tank guage
•Probe Test Date
Sensor Test Date
Console Test Dab
IM Sensor Teat Dab
3.Tight testing every 5 firs for only 10 yrs w/finventory control
Date of Tank Tightness Test 711212016
4.Tank fighness testing once every 5 years far only 10
years with manual tank gauging(inly tanks 551-2D00 gal.)
5.Interstitial monitoring
Monthly log date
Type of IM method far above
6.Vapor monitoring
Vapor Approval Date
7.Groundwater monitoring
Groundwater Date
S.Manual tank gauging(only tanks 1000 gal.Or less)
9.Statistical Invento 'RecondltaHon(SIR %
SIR Annual Report Date(Year only) 12003
11 Other..Please specify
N.Pressurized Piping Method of Release D_et_ection. -
Conipinho t Sum
Sump Test Date
Annual Inspection Date 111/1901
'1.GROUP I (Mark one of the follow i ng)
a.Automatic Flow Restrictor(MLLD]
Annual Test Date 11/21I2019
P.Automatic shutoff device(ELLD) _
ELLD Test Date
c.Continuous Alarm System
Sump Sensor Test Date
d.Sump Sensor Relayed
Sump sensor relayed Test Date
d.Omer,Please Specify
B.GROUP II.(Markone ofthefollowing)
a.Annual Line Testing x
Line Test Date 11121/2019
b.Automatic electronic line leak detector
c.Vapor Monitoring SAME AS FOR TANKS
d.Groundwater Monitoring(SAME AS FOR TANKS
e.Statistical Inventory Reconciliation SIR
f.Interstitial monitoring
Monthly Log Date
Type of IM method above
.Other,Please Specify
O SUctioo Piping Method of Release Defectlon(Mark doe
I.Line tightness testing every 3 years
Date of Line Test _
2. Interstitial monitoring _
Type of IM method above _
3.Vapor Monitoring SAME AS FOR TANKS
4.Groundwater Monitoring (SAME AS FOR TANKS)
5.Safe Suction
6.Statistical Inventory Reconciliation(SIR)
7 Other,Please Specify
P Gravity PipingfNdledk detechonrequired) � _-_— _ =— —_ -
V_UIC(If yes tathe next question send copy of this report to UST/l1ST.Cpmplidnce Section Chief)
Are there floor drains[ran automobile repair shop that discharge to field lines at this facility? YES NO
■ I 1111 . � 1 ■
Are ASTs on site? ❑Yes No
r Did Inspector provided owner/operator with AST guide nce? (Piease provide lfASTspresent' El Yes O No N/a
Does the site use interstitial monitoring? ❑Yes EFG
Was all stage 1 vapor recovery equipment inspected? es 0 No 0 N/a
._r � Rele33@Ge2ectlah. . v `.:,
Verifies ATG console operatingproperly? - ❑Yes o O N/a Site Meets RD Performance
Verify SIR Annual Report []Yes 0No'QIt/a Measure
Verified Group i release detection records for piping es 13 No
Verified Group ll release detection records for piping- Yes 0 NNo
❑Yes f9110 Upending
Documentation of proper release detection equipment testing ❑Yes f3(o
(Applicable testing from PSTEST&RDTEST forms)
Cartoslorcprei?"epdan '°� '" .CAM.;' t,
Type of CP at site Olmpressedi ❑Galvanic one(F(itanks/lines) Site Meets CP Performance
Was Rectifier powered on and showing volt and amp readings P07 p Yes ❑No E N/a Measure
C only)
Was Rectifier log present and up to date? ❑Yes'O No RWa I➢'Yes O No OPending
If IC,not part of performance measure
Verified documentation of 3 year CP testing? ❑Yes []No N/a
SPIIIPreventibn
Documentation of 3 year spill bucket test Yes ❑No Site Meets SP Performance
Are Spill buckets free of visible cracks/holes? Yes ElNo
Are Spill buckets free of product/sludge/water? Measure
p'Yes [IN o ❑Yes 0 No OPending
`• overfill Prevention
Does site appear to have functioning overfill prevention devices? [,yes Don Site Meets OF Performance
Documentation of overfill Inspection Measure
par new sites imtal/ed on or after 12/8/17 or by 1218120) ❑Yes ❑No ❑Yes O No 0Pending
">.. : .I Technical Compliance Determination .
Site is in Technical Compliance es LN No OPending
Site is in technical compliance if it meets all measures above:RD,CP,SP&OF
Documentation of 30 day walkthrough inspections C�Yes ❑No Site Meets Walkthrough
(MusthavelDouto 1l months of30 day Inspections) Measure
Documentation of annual walkthrough inspections des ❑No []Yes O No Upending
:DontalbmentsampT '
Were all Containment sumps Inspected? ❑Yes O NoEf N/a
Containment sumps were free ofwater/debris/product? ❑Yes 0 No aN/a
ft]alybaustbe olwoter! used rfnttrstltlal monkoM
Did the site have documentation of containment sump integrity test? ❑Yes U No[P-N/a
(Por saes instaaedonoraRerl2/8/12andlor sties aslnp kN&srNialMmritodnpb 12/8/2a)
Sensors mounted at low point of sump ❑Yes 0 No R*N/a
-: - Under Dispenser Containment
Was UDC inspected and found to be satisfactory? ❑Yes❑ No U Not Observed
Did the site have documentation of UDC integritytest? ❑Yes ❑ No f9�N/a
' o erator Tmining
Has the Owner completed A/B operator training? Id Yes 0 No❑
fVer*jhsmdatutiose,certificate notrequiredto be kepton snef
Was a Class C operator training records available on site? ❑Yes O No❑
(Rewrdsfor all current closs Copennon must be Lept of tbeja`dlltyper ulatlans) -
Please complete this page during the inspection and scan with the Compliance Inspection Record