HomeMy WebLinkAbout5000 017859 097 03-12-2020 ANWALK SLA ANNUAL WALKTHROUGH INSPECTION 57593.06 QI,S��q ANWALK 3-IZ-Zc�10
ADEM
ANNUAL WALKTHROUGH INSPECTION CHECKLIST LOG FOR YEAR 90M
AuesSom on We to Ie the forth Mould be directed to the Groundwater Branch,UST Compliance Section at(3 27p 55
Facil Name: y�,ry /bL...k<k Owner: M �r Oi
Address: dare. .,ay-4
Address: CIM .'a VaL S.t.YgO
Ck Coun 2i 36 Cof. state LID: L .1JW
Facil' I.D. #: -7 af9 -0\ - 01 Phone#:
In 1,actor Com Name: T:>?�. tt' inspector Phone#:
In actor Pan : o �c:w
Installation
1. This form allms you to record up to 5 ADEM Unique Tank Numbers,assuming that the Facility ID Number remains the same.
2. Complete potion of form pertaining to type of equipment inspected for each tank.
3. Inspection must be performed in accordance with a nationality recognized code of practice(such as PEI RP-900,Or equrvatend),
manufacturers Instructions.or ADEM requirements.
4. Keep a record copy of this Impetilon for 1 year.
ADEM Unique Tank or
Disipmosara 'ZU 10
Product Stored 1AA. ti(,
Stle using Interstitial Leak ❑Yea �m ❑ es W n no
Detection for Piping? Y ❑yes ❑no ❑yea ❑m ❑yes ❑m
Containment Sump Inspection
Type of containment sump 121'suld pump Muld pump ❑sub pump ❑sub pump ❑sub Pump
inspected ❑intermediate ❑intermediate ❑intermediate ❑iraernediate ❑intermediate
❑dispenear ❑dISIDenser ❑dispersear ❑dispenser ❑disperser
Visually checked sump for B yes Wyeds ❑yes ❑yes ❑yes
damage? ❑no ❑no ❑m ❑no ❑re,
Integrity,of both walls of double ❑yes ❑yes ❑yes ❑yes ❑yes
walled sump verified by checking ❑no ❑no ❑no ❑no ❑red
interstitial spice
far leaks? n!a Q'Na ❑n1a ❑Na ❑Na
Sump checked for leaks of water yes yes ❑yes ❑yes ❑yes
or fuel into the conainment area? ❑ 0 ❑ o ❑no ❑m ❑m
Water,fuel and/or debris found in yes yes ❑yes ❑yea ❑yes
sum ? ❑no ❑no ❑nc ❑m ❑no
Water,fuel and/or debris removed ❑yes ❑yes ❑yes
from sump and disposed of ❑no ❑no ❑no ❑rat ❑no
PrODE,n 7 ❑Ne ❑r9a ❑Na ❑Na 01112
Visually checked sump for any OW 2,yes ❑yes ❑yes ❑yes
releasas to the enviro1111ent? ❑ ❑ 0 ❑no Elm ❑no
All penetrations 4 be conduits, yes yeti ❑yes ❑yeti ❑yes
etc.)into sump in good condition? ❑no ❑'n/a ❑no ❑•nfa ❑no ❑We ❑m ❑•Na ❑had ❑'Na
Piping Interstitial Spam open to
sump to allow piping leak of O❑yes ❑yes Dyes ❑yea ❑yes
rotlutl to enter sump? no p'F/a ❑no FTrNa ❑no, ❑'Ma ❑m ❑We ❑no ❑•Na
Sansom positioned properly EI yes IffYes ❑Yes ❑yes ❑yes
near bottom of sump? ❑Q2 ❑•Na 1 ❑no ❑•Na ❑no ❑•Na ❑no ❑Wild ❑m ❑We
Visible piping In good contlllion? yss Yea ❑yes ❑yes ❑yes
❑m Ono ❑m ❑no Ono
Inspectors pec
date in pecked
Hand Held Release Detection E ul meth Inspection
gauge stick Urgauge sock ❑gauge stick ❑gauge stick ❑gouge stick
Type of hand hold release ❑groundwater ❑groundwater ❑groundwater ❑groundwater ❑groundwater
detection equipment bailer bailer bailer bailer bailer
❑other(specify): ❑other(specify); ❑other(specify): ❑other(specify): ❑other(specify):
Results of operability and peas p pace
servlceionliry lnspectlon ❑fall ❑fails ❑falls ❑fall ❑fall
Inspectors initials and
dateine aed
Repalm Needed Date of Repair Description of any Repairs
•n/a only for sites with double wall piping rect using interstitial leak detection.
ADEM Forth 193/11(revised Nils)
ANWALK
ADEM
.ANNUAL WALKTHROUGH INSPECTION CHECKLIST LOG FOR YEAR d 0
Questions on how to complete this torte should be dlreaed to the Groundwater Branch,UST Compliance Section at(334)?]m-5555
Facilil Name: l•e Owner. r 0i
Address: 2 . Address: 1 Cowwawo ul
s
Clt ,Count Zi : f Cy, State,Zi :
Facilil I.D.#: 21-yN - ql- oil Phone#:
Ins for Name: w Ins e#: Z rPhon -Y -o
Ins ectr Com n : •
Insimctlons
1. This forth allows you to retard up to 5 ADEM Unique Tank Numbers,assuming that the Facility ID Number remains the same.
2. Complete pomon of form pertaining to type of equipment inspected for each tank.
3. Inspection must be performed in accortlarica with a nationally recognlaed code of practice(such as PEI RP-600,or equivalent),
manufacturefs instructions.or ADEM requirements.
4. Keep a record copy U this inspection for 1 year.
ADEM Unique Tank#or
Dispenser# 1 7- 3N 6A I Ih-
Product SW;;d (AL- I IAL CAL,
Site Using Interested Leak O yes Id no ❑yes Who ❑yea (Yno Oyes Orrin ❑yes ❑no
Detection for PI ?
Containment Sump Ins wtion
Type of containment sump O sub pump ❑sub pump ❑sub pump O sub pump ❑sub pump
inspected ❑intermediate O intamsdiata ❑intermediate ❑intermediate ❑intermediate
91raispensair E'B nser E"isparmser Eraspenser O disperser
Visually checked sunp for Bges Ries arrfea yes O yes
damage? ❑rg O no O M ❑no ❑no
Integrity of both walls U double ❑yea ❑yes ❑yes ❑yea ❑yea
walled sump verified by checking ❑no ❑no ❑no ❑no ❑W
interstitial s ae forleok Rma Dfull Ra R'F//a ❑Na
f 6 ❑yesSump checkedawater yes or fuel into the containment area? ❑no ❑no O no O no ❑no
Water,fuel and/or debris found in ❑yea ❑yea Dyes ❑yes O yes
sump? P160 no t)'ho Eno O no
Water,fuel and/or debris removed ❑yes O yes ❑yea ❑yes ❑yes
from sump and disposed of O no ❑no ❑no O no ❑no
promn ? E'h/a R`Na Riga Gma ❑n1a
Visually checked sump for any s .R'9u Oyes O yes
releases to the environment? O no ❑no ❑rso ❑no O no
All penetrations(boots.collude. Oyu au u ❑yes
etc.)into slump in good condition? D no O•r✓a Ono O•n/a O rw D'Na D no ❑'rua O no ❑'Na
Piping Intemtibal space open to O yes O yes ❑yes yes ❑yea
sump to allow piping leak of O 1110 B'hna O no E rda O no R'Fi/a O no E hie D no ❑'Na
reduU toentersum ?
Sensors positioned properly Oyu ❑yea ❑yes, O yes ❑yell
near bottom of IMP? O no Z'n/a O no RrNa O no 0'nnfa O no E�Na O no ❑*we
Visible piping in good condition? R'Yes all s Oyes
Oto Ono ❑no Ono Ono
Inspector's initials and
date inspected -"Il/JU —.A-- vV'/go / /
Hand Hold Role a Detection Equipment Ins cdon
C4auge sWk gauge stick auge stick Urgauge stick ❑gauge stick
Type of hand held release O groundwater ❑groundwater ❑groundwater ❑groundwater ❑groundwater
Detection equipment bailer bailer bailer bailer bailer
❑other(specify): ❑other(specify): O other(specify): D other(specify): D other(specify):
Results of operability and pass Orpairs au au Opass
serviceability Inspection Ofall ❑fall Ofall ❑fail Ofail
Inspectors inhials and
date inspected 4 7 /al;ts 3 1p 3 v- 3f�Zy�q
Re airs Needed Dab of Repair Description of any Repairs
Wa only for sites with double wad piping not using Interstitial leak detection.
ADEM Form 19 NI I(revised 3/18)
Thomas, Angelicia J
From: MPE Front Office <front.office@mckinneypetroleum.com>
Sent: Wednesday, March 18,2020 3:53 PM
To: UST Compliance Mailbox
Subject: FID#21749-097-17859
Attachments: Myers Market FID#21749-097-17859 Annual Walkthrough 2020.pdf
Please upload the attached.
Karmen L. Etheredge
McKinney Petroleum Products
3926 Halls Mill Road (36693)
P.O. Box 9099
Mobile,AL 36691
Office: (25i)661-8800
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