HomeMy WebLinkAbout6504 014657 015 01-26-2021 REGINP JDT COMPLIANCE INSPECTION 60030.97 FACILITY I.D. NUMBER: Z (} 1 REGINP
ADEM
NOTICE OF UNDERGROUND STORAGE TANK UST COMPLIANCE INSPECTION
ADEM Administrative Code Rule 335-&15 Compliance Inspection Authorization
F335-6-15-.40 Access to Records. Any owner or operator of an underground storage tank shall upon request of a duly authorized representative of the Department,permit the representative,at all reasonable times,
access to all records concerningthe storage of regulated substances and permit therepresentative to co said records.
335-6-15-.41 to
and Inspection of Facilities. Any owner or operator of an underground storage tank shall upon request of a duly authorized representative of the Department,permit the representative to enter,
t all reasonable times,property and buildings where an underground storage tank is located and allow therepresentative to inspect facilities and equipment and to conduct monitoring and sampling.
Routine Compliance Inspection ❑Prior Notice Inspection ❑Follow Up inspection from:
Owner Name k.c #Of USTs
Mailin Address p Facility Name j3 c
jr JILA7—
City D'k�u,ydStat Ac., zip ?p Street Addr s U E'
Owner Email Addres ,/ ✓J� Count Cit Nea st
p 3 9 Submit Desi nated Notifications
❑Suspected Permanent I ❑Temporary installation ❑Transfer of ❑Notification ❑Other:
Release(form 480) closure(form 422) closure(form 310)TE]New
or upgrade(form 423) ownership(form 469) (form 279)
Submit Designated Regulatory Fees
UST regulatory fee payment due for: ❑Current fiscal year ❑Prior fiscal years,specify:
Su mit gesignated Delinquent Test Reports
[]Annual line tightness test (0.1 GPH)(form 477) t,
?j `?,�j z_ ❑Annual test of automatic line leak detector(form 551)
❑Annual SIR 30 day results summary(form 326) ❑ 3 year Catchment basin(spill bucket)test(form 20)❑ S/SL/�Z
3 year UST impressed current cathodic protection test, (form 332) El year containment sump integrity test(form 557)
❑3 year Piping impressed current cathodic protection to t(for 332) ❑Annual probes and sensors test(form 560)
I 3 year galvanic cathodic protection test form 545 f !s 7io Z ❑Other:
Subm t M t Recent Designated Additional Test Data
❑30 day ATG 0.2 gph test printout ❑30 day tank interstitial sensor printout
❑30 day CSLD test printout ❑30 day manual interstitial monitoring log(form 406)
❑30 day SIR report log(form 326) ❑Electronic line leak detector 3.0 gph test printout
❑Annual release detection equipment testing log(form 561) ❑Monthly electronic line leak detector 0.2 gph test printout
❑30 day containment sump sensor printout ❑Annual electronic line leak detector 0.1 gph test printout
❑30 day manual tank gauging to (form 563) ❑Other:
Submit Designated Operation and Maintenance Inspection Results
❑60 day impressed Current CID Inspection Log(formZ
0) ❑Annual walkthrough inspection log(form 19)
❑3 year overfill prevention inspection(form' 'z ❑Monthly walkthrough inspection log(form 558)
Oper tion nd Maintenance Needing Immediate Action
Containment Sumps Containment Sump Equipment Operator Training
[]Empty water&properly maintain sump(s) ❑Properly position sump sensor(s) ❑ Submit A-B operator training record
❑Empty fuel or fuel/water mix,dispose of properly& ❑Sump sensor must shut off sub pump ❑Submit C operator training record
properly maintain sump(s) ❑Clear fuel alarm from sump sensor(s) Compatibility
[]Repair sumps and/or sump equipment as necessary ❑Replace missing line leak detector(s) ❑Submit missing compatibility logs
to prevent liquid from entering sumps ❑Replace deteriorated flexible piping Temporary Closed Tanks
Tank Cathodic Protection Rectifier Spill Prevention Equipment ❑Perform leak detection
❑No amps or volts-restore power or fix meter ❑Remove fuel/water-dispose of properly ❑Monitor corrosion protection every 60 days
[:]Amps reading too low-mpairs ter I&retest I ❑ Repair damaged spill catchment basins ❑Remove remaining contents to 1 inch or less
Inspector Comments:
L ® iO
Submit any requested information to the atte tion of the inspector at the ress indicated below, fax to the inspector's attention,
or e-mail to the inspector at: rC�Q✓►�;Vlq -E; @adem.alabama.gov
ADEM❑Field Operations❑La d ADEM,�Birmingham Field Office ADEM❑ obile Field Office ADEM❑Decatur Field Office
Division Office,P.O.Box 301463 110 Vfilcan Road 2204 Peri eter Rd. 2715 Sandlin Road, S.W.
Montgomery,Alabama 36130-146 Birmingham,Alabama 35209-47�2 Mobile, labama 36615-1131 Decatur,Alabama 35603-1333
Phone/Fax# 334 Phone/Fax# 205 Z- Phon ax# 251 - Phone/Fax# 256
Compliance Inspecti esults
❑ No Action Required-Thank you for your continw omp wi M e ADEM UST regulations.
❑ Additional Information Requested Delinquent Information Required ❑ Immediate Action Required within 24 hours
Submit requested information/confirmation 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 the Department's Delivery Prohibition Website.
NOTE: THE ABOVE FACILITY WAS INSPECTED TO DETERMINE COMPLIANCE WITH ADEM ADMINISTRATIVE CODE RULE 335-6-15. THE STATUS
OF COMPLIANCE IS INDICATED ABOVE.
Receipt of this"ADEM UST Compliance Inspection"is hereby acknowledged by the facility owner or representative.
If other than the owner receives this notice,i uld i iately be forwarded to the owner of the USTs.
Si a er cir r. er "rmnted Nam ✓f
ADEM FO M 86 m1 m2(r sed 3/18) TOP COPY-FILE O COPY-OW ❑ Suppl ent Page 2 Completed
1/12/2021
, . ADEM LIST INSPECTION CHECKLIST Printed
Owner Name: JACK GREEN OIL CO INC Page 1
Owner Type : P P O BOX 7040
OXFORD AL 36203
Owner Phone: 2568311038 Fax Phone: 2568315705 OPERATOR TRAINING:
Owner Contact Name: GARY HARRIS
YES
Owner Contact Phone: 2562386569
Email (verified from web): Email (OLD unverified) greenoil@jackgreenoil.com
Number of Sites: 13 The Fiscal Account information is provided Owner Fee Information FY 2021 2020
GSA ID: to aid in the inspection process only. It
r' reflects the Owner's account status as of the Billed Amount 360 360
Bad Address: printed date and is subject to change on a
daily basis based on payments made and Paid Amount 0 360
NO Bill: number of tanks in service during the year.
SITE DATA...............................................Date of last walk Thru 1/28/2020 Cannot locate Site:
Site Name: GREEN OIL CO BULK PLANT Abandoned Site.
1808 HWY 78 E & INDUSTRIAL DR Adjacent to residence
OXFORD AL 36203 Within 300 feet of residence:
Site Contact Name: GARY HARRIS Located within Indian Lands:
Site Contact Phone: 2058311313 Located within Wellhead Protection Area:
Email (verified from web): Email (OLD unverified
................................................GPS Data.....................................................
Location: Decimal Deg Degrees Minutes Seconds ..............Verified..............
Latitude: 33.614332 33 36 51.595000 Code:
Longitude: -85.801082 -85 48 3.895000 Date:
Stagel facility number: 301-G-046 NOTE: This facility has tank system(s)
Number of USTs: 7 and/or piping installed/upgraded after August Number of ASTs: 0
Currently in use: 7 6, 2007 that require different forms of leak Active ASTs: 0
detection.
Temporarily Closed: 0
3 YR Insp tanks: 7 NOTE: Site has no tanks with compatibility
Permanently Closed: 0 demonstration needed.
Retired: 0
Contested: 0 Date Last Inspected: 9/25/2018
Inspector Comments:
Facility.1 D. 12144 015 014657• ADEM UST INSPECTION CHECKLIST Printed1/12/2021
Owner Name: JACK GREEN OIL CO INC Page 2
Site Name: GREEN OIL CO BULK PLANT
1.Description of • storage tanks
us (Mark all that apply) TANK ID NO;� 13476 U 07 013481 U 01 013482 U 02 013483 U 03 013484 U 04
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
1.Date Installed 1/1/1987 1/1/1988 111/1988 1/1/1988 1/111988
D.Tank Estimated Total Capacity(gallons) 8000 6000 6000 6000 6000
1.Number of compartments if compartmented tank 1 1 1 1 1
2.Number of manifolded tanks if manifolded 0 0 0 0 0
Substance Currently Sfo`red(Mark all`that'apply)
a.Unleaded Gasoline
b.Mid-Grade Gasoline
c.Premium Gasoline
d.Diesel
e.Kerosene
f.Aviation Fuel(JP-4),etc.)
g.Used Oil
h.Virgin Oil
L E-85
J.Biodiesel
I.Other,Please specify OFFROAD
2.Hazardous Substance
a.Please indicate Name of Principal CERCLA Substance or
b.Chemical Abstract Service (CAS) No.741
I
sage(Mark all that apply)
1.Emergency Power Generator (Part IV not required)
2.Retail X X X X X
3.Bulk Facility X X X X X
4.Industrial
5.Local Government
6.State/Federal Government
7.Farm
8.Heating Oil (Notification not Required)
Information for this FY as
- — - - -0- - -0 0
Fe
Tank Comments for Tank 13476 Tank Comments for Tank 13481
SUPPLIER:GREEN OIL-OWNER STAGE ONE:2 TANKS,2 DUAL POINTS AND TWO
SEPARTE VENT LINES ATG TLS350 7CSLD-6 LINE LID AND SUCTION NO SUMPS&5
DISPENSERS W NO PANS
Tank Comments for Tank 13482 an Comments for Tank 13483
Tank Comments for Tank 13484 013476 E_COMPATIBILITY_REQUIRED: ❑ E_COMPATIBILITY_VERIFIED❑
013481 E_COMPATIBILITY_REQUIRED: E_COMPATIBILITY_VERIFIED❑
013482 E_COMPATIBILITY_REQUIRED: E_COMPATIBILITY_VERIFIED
013483 E_COMPATIBILITY_REQUIRED: H E_COMPATIBILITY_VERIFIED
013484 E_COMPATIBILITY_REQUIRED: ❑ E_COMPATIBILITY_VERIFIED
I I I • I , : . •
Owner Name: JACK GREEN OIL CO INC Page 3
Site Name: GREEN OIL CO BULK PLANT
11.Corrosion Protection
Tgnk Construction Material(Mark afl'tha 013476 U 07 013481 U 01 013482 U 02 01341*211111c 013484 U 04
Single Wall x x x x
Double Wall
1.Steel x x x x x
2.Fiberglass Reinforced Plastic
3.Fiberglass Coated Steel
4.Other,Please Specify
eel Tank Corrosion.Protection,(Mark all that,apply)'
1.Galvanic Cathodic Protection x x x x x
2.Impressed Current Cathodic Protection
Date cathodic protection installed
3 YR CP REVIEW P P P P P
3 YR CP TEST DATE 1/15/2018 1/15/2018 1/16/2018 1/15/2018 1/15/2018
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
:Piping Material Of Construction (Mark all that apply)
Single Wall x x x x x
Double Wall
Installation Date
1.Steel
2.Fiberglass Reinforced Plastic x x x x x
3.Flexible
Manufacturer
4.Other material or piping information
�aectfon'(Mark all that apply
1.Impressed Current Cathodic Protection
2.Galvanic Cathodic Protection(e.g.sacroficial anode)
3.Isolated or Above Ground
Date protection installed
3 YR CP REVIEW
3 YR CP TEST DATE
4.None or N/A
5.Other,Please specify
Spill/Overfill
' Tank Spill Prevention Equipment (` th
1.Catchment Basin x 15/14/27018
x x x
Test Date 6/14/2018 6/14/2018 6/14/2018 6/14/2018
Reviewed P P P P
2.Other,Please specify
3.Not required
L.Tank Overrilll Prevention Equipment(Mark a t- ply)
1.Flow Restrictor at 90%full (e.g.,ball float vent valve) x x x x
2.Auto Shutoff Device at 95%full(e.g.flappervalve) x
3.High Level Alrm at 90%full (must alert fuel deliverer)
Test Date 5/18/2018 8/4/2018 8/4/2018 8/4/2018 8/4/2018
4.Other,Please specify
Comments:
• ADEM UST INSPECTION CHECKLISTPrinted 1/12/2021
Page 4
IV.Release Detection
r s of Release Detection (Mark all that apply) 013476 U 07 j 013481 U 01 013482 U 02 013483 U 03 013484 U 04
1.Automatic tank gauge
2.Continuous Automatic tank guage
Probe Test Date 7/30/2020 7/30/2020 7/30/2020 7/30/2020 7/30/2020
Sensor Test Date
Console Test Date 7/30/2020 7/30/2020 7/30/2020 7/30/2020 7/30/2020
IM Sensor Test Date
3.Tight testing every 5 yrs for only 10 yrs w/inventory control
Date of Tank Tightness Test
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
8.Manual tank gauging (only tanks 1000 gal.or less)
9.Statistical Inventory Reconciliation (SIR)
SIR Annual Report Date(Year only) 2010 2010 2010 2010 2010
11.Other,Please specify (At least one item from BOTH Group I and Groupil must be marked
Containment Sum
Sump Test Date
Annual Inspection Date 1/1/1901 1/1/1901 1/1/1901 1/1/1901 1/1/1901
ROUP I (Mark one of the following)
a.Automatic Flow Restrictor(MLLD)
Annual Test Date 5/17/2019 7/30/2020 7/30/2020 7/30/2020 7/30/2020
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
2,GROUP II (Mark one of the following)
a.Annual Line Testing X X X X X
Line Test Date 6/17/2019 7/30/2020 7/30/2020 7/30/2020 7/30/2020
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
g_Other,Please Speci
.Suction Piping Metho .
1.Line tightness testing every 3 years E
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
G in No leak detection re wired) "�
---
3
UIC(If yes to the next question,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. D. 12144 - 1 014657 ADEM • -• 1/12/2021
Owner Name: JACK GREEN OIL CO INC Page 5
Site Name: GREEN OIL CO BULK PLANT
1.Description of underground storage
A.Tank status (Mark all that apply) TANK ID NO: 013485 U 05 045061 U 06 1
1.Currently in Use 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
1.Date Installed 1M/1988 1/1/1901
D.Tank Estimated Total Capacity(gallons) 1000 4000
1.Number of compartments if compartmented tank 1 1
2.Number of manifolded tanks if manifolded 1 0 0
E.Substance Currently Stored (Mark all that apply)
l
a.Unleaded Gasoline
b.Mid-Grade Gasoline
c.Premium Gasoline
d.Dlesel -
e.Kerosene
f.Aviation Fuel (JP-4),etc.)
g.Used Oil
h.Virgin Oil
I.E-85
j.Biodiesel
i.Other,Please specify MNRLSPIRIT
2.Hazardous Substance
a.Please indicate Name of Principal CERCLA Substance or
b.Chemical Abstract Service(CAS) No.
1.Emergency Power Generator(Part IV not required)
2.Retail X
3.Bulk Facility X
4.Industrial X
5.Local Government
6.State/Federal Government
7.Farm
8.Heating Oil (Notification not Required)
ee informaflW.for this FY as of date printed., Fees billed
Fees paid
Tank Comments for Tank 13485 Tank Comments for Tank 45061
013485 E_COMPATIBILITY_REQUIRED: E_COMPATIBILITY_VERIFIED
045061 E_COMPATIBILITY_REQUIRED: E_COMPATIBILITY_VERIFIED
ADEM UST INSPECTION -• 1/12/2021
Owner Name: JACK GREEN OIL CO INC Page 6
Site Name: GREEN OIL CO BULK PLANT
11.Corrosion Protection
G._Tank Construction Material (Mark all that apply) 013485 U 05 045061 U 06
Single Wall _ X X
Double Wall
1.Steel X X
2.Fiberglass Reinforced Plastic
3.Fiberglass Coated Steel
4.Other,Please Specify
I.Steel Tank Corrosion ProteG on (Mark all that apply)
1.Galvanic Cathodic Protection X X
2.Impressed Current Cathodic Protection
Date cathodic protection installed
3 YR CP REVIEW P P
3 YR CP TEST DATE 1/16/2018 1/15/2018
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
Piping Material Of Construction(Mark all that apply)
Single Wall X X
Double Wall
Installation Date
1.Steel
2.Fiberglass Reinforced Plastic X X
3.Flexible
Manufacturer
4.Other material or piping information
1.Impressed Current Cathodic Protection
2.Galvanic Cathodic Protection(e.g.sacroficial anode)
3.Isolated or Above Ground
Date protection installed
3 YR CP REVIEW
3 YR CP TEST DATE
4.None or N/A
5.Other,Please specify
Spill/Overfill Protection
,.Tank Spill Prevention Equipment(Mark all that apply)
1.Catchment Basin X
Test Date 5/14/2018
Reviewed P
2.Other,Please specify EXEMPT
3. Not required
L.Tank Overfilll Prevention Equipment(Mark all that apply) -
1.Flow Restrictor at 90%full (e.g.,ball float vent valve)
2.Auto Shutoff Device at 95%full (e.g.flappervalve) X
3.High Level Alrm at 90%full(must alert fuel deliverer) -
Test Date 5/18/2018
4.Other,Please specify EXEMPT
Comments:
Page 7
'IV.Release Detection
)vl.Tank Methods of Release Detection (Mark all that apply) 0134$5 U 05 045061 U 06
1.Automatic tank gauge
2.Continuous Automatic tank guage
Probe Test Date 7/30/2020 7/30/2020
Sensor Test Date
Console Test Date 7/30/2020 7/30/2020
IM Sensor Test Date
3.Tight testing every 5 yrs for only 10 yrs w/inventory control
Date of Tank Tlghtness Test
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
8.Manual tank gauging(only tanks 1000 gal.or less)
9.Statistical Inventory Reconciliation (SIR)
SIR Annual Report Date(Year only) 2010 2010
11.Other,Please specify
Pressurized Piping Method of Release Detection (At least • - item fromBOTH Group I • • Groupll must be marked
Containment Sum
Sump Test Date
Annual Inspection Date 1/1/1901 1/1/1901
1.GROUP I (Mark one of the following)
a.Automatic Flow Restrictor(MLLD) f
Annual Test Date 5/17/2019
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
of the fo(lowmg)
a.Annual Line Testing X
Line Test Date 5/17/2019
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
Ty a of IM method above
Other,Please Specify
iping Method of Release Detection(Mark one)
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
in No leak detection re wired X
IJIC (If yes to the next question,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
AINSPECTION CHECKLIST SUMMARY DEM UST • _• 1/12/2021
Site Observations
Are ASTs on site? Yes ❑ NO
Did inspector provided owner/operator with AST guidance? (Please provide if ASTs present) Yes ❑ No ❑ N/a
Does the site use interstitial monitoring? ❑ Yes No
Was all stage 1 vapor recovery equipment tested? Yes ❑ No ❑ N/a
Release Detection
Verified the ATG console operating properly with 1 year of printouts Yes ❑No ❑ N/a Site Meets RD Performance
Verify SIR Annual Report ❑Yes ❑No /a Measure
Verified Group I release detection records for piping Yes ❑ No
Verified Group II release detection records for piping Yes ❑ No
Documentation of proper release detection testing Yes El No ❑Pending
Yes ❑No / _
(Applicable testing forms:ATGTEST,LSTEST,RDTEST,LINETT,LDLTTEST)
Corrosion Prevention
Type of CP at site ❑ Impressed(IC) Galvanic ❑ None(FG tanks/lines) Site Meets CP Performance
Was Rectifier powered on and showing volt and amp readings>0? ❑Yes ❑No N/a Measure
(IC only)
Was Rectifier log present and up to date?(If IC,not part of performance measure) ❑Yes El No �pN/a ❑Yes 4No ❑Pending I
Verified documentation of 3 year CP testing? ❑Yes No ❑ N/a
Spill Prevention
Documentation of 3 year spill bucket test Yes ❑ No
Are Spill buckets free of visible cracks/holes? Yes ❑ No Site Meets SP Performance
Are Spill buckets free of product/sludge/water? Measure
(Water may be present in spill bucket as long as there is not an obvious f�9 Yes ❑No [ Yes ❑ No ❑Pending
lack of maintenance)
Overfill Prevention
Does site appear to have functioning overfill prevention devices? IKYes ❑No Site Meets OF Performance
Documentation of overfill inspection Measure
Yes El No
(Due by Dec 8,2020,not part of OF measure until Dec 8,2020) Yes ❑ No ❑Pending
Technical Compliance Determination
Site is in Technical Compliance
Site is in technical compliance if it meets all 4 measures above: RD, CP,SP&OF El Yes No ❑Pending
Walkthrough Inspections
Documentation of 30 day walkthrough inspections Yes El No Site Meets Walkthrough
(Must have 10 out of 12 months of 30 day inspections) Measure
Documentation of annual walkthrough inspections �yYes ❑No
Yes ❑ No ❑Pending
Containment Sumps
Were all Containment sumps inspected? ❑ Yes ❑ No N/a
Containment sumps were free of water/debris/product? ❑ Yes ❑ No PN/a
(Only must be free of water if used for interstitial monitoring)
Did the site have documentation of containment sump integrity test? ❑ Yes ❑ No �F N/a
(Due by Dec 8,2020 for sumps used for interstitial monitoring only)
Sensors mounted at low point of sump ❑ Yes ❑ No N/a
Under Dispenser Containment
Was UDC inspected and found to be satisfactory? ❑ Yes ❑ No pr Not Observed
Did the site have documentation of UDC integrity test? ❑ Yes ❑ No N/a
Operator Training
Has the Owner completed A/B operator training? Yes El No
(Verify from database,certificate not required to be kept on site) Iw
Was a Class C operator training records available on site? Yes ❑ No
(Records for all current class C operators must be kept at the facility per regulations) 1)6
Please complete this page during the inspection and scan with the Compliance Inspection Record
I
DRAFT Preliminary list of Deficiencies found during Site inspection Printed 1/12/2021
0_2PELLD 0_2T F-� 279 [::] 3_OELLD
ALARM CHIOWN F7 CloRpt El CPLog
CPTest® ePwr F� Fees EJ INTLining
LTT MLLDF F--] MLLDlnstall El MLLDT
OverFill F-1 SIRContract F7 SIRMON [:] SIRROX Ej
SPILLF a SPILLMT F--1 SPILLR a SPILLT
SUMPI SumpMT a SUMPR SumpSensorT EJ
TEMP F--1 OPTRGN F-'] WLKTHRU
Inspector Name: IZo �/ll• �o�� Inspector Signature:
Inspection Date: 6 /26/� Z I