HomeMy WebLinkAbout12727 003964 101 12-16-2020 ANWALK SLA ANNUAL WALKTHROUGH INSPECTION 65971.29 ANWALK
ADEM
ANNUAL WALKTHROUGH INSPECTION CHECKLIST LOG FOR YEAR 2020
Facility Name: United Food and Fuel#14 Owner: McNeill Family
Address: 1192 Western Blvd. Address: Po Box 11
City, County,Zip: Montgomery, Montgomery, 36108 City, State, Zip: Montgomery,AL 36101
Facility I.D.#: 12899-101-003964 Phone#: 334-263-9070
Ins ector Name: Klinswetes Inspector Phone#: 334-300-0984
Inspector Company: Inspection Date: 12-16-20
Instructions
1. This form allows you to record up to 5 ADEM Unique Tank Numbers,assuming that the Facility ID Number remains the same.
2. Complete portion of form pertaining to type of equipment inspected for each tank.
3. Inspection must be performed in accordance with a nationally recognized code of practice(such as PEI RP-900,or equivalent),
manufacturers instructions,or ADEM requirements.
4. Sites with safe suction piping are not required to complete the containment sump inspection portion of this torte.For sites with safe
suction piping and no hand held release detection equipment,completion of this form is not required.
5. Keep a copy of this inspection for 1 year. Questions on how to complete this form should be directed to the Groundwater Branch,
UST Compliance Section at(334)270-5655.
ADEM Unique Tank NO or 1 2 3
Dispenser#
Product Stored Gasoline Gasoline Diesel
Is the Site Using Interstitial Leak 11 Detection for PI In 7 yes ®no El yes ® no El yes ®no ❑yes ❑ no ❑yes ❑ no
Visual Containment Sump Inspection
Type of containment sump 0 sub pump ®sub pump M sub pump ❑sub pump ❑ sub pump
inspected 0 intermediate ❑intermediate ❑ intermediate ❑intermediate ❑ intermediate
®dispenser M dispenser ® dispenser ❑dispenser ❑dispenser
Is the sump an earthen sump? IS yes IN yes ®yes ❑yes ❑yes
❑no ❑no ❑ no ❑no ❑ no
Is the visible piping in good IS yes ®yes ®yes ❑yes ❑yes
condition? ❑no ❑no ❑ no ❑no ❑ no
Is there evidence of a release? 0 yes ❑yes ❑yes ❑yes ❑yes
If release found,report it to ADEM 10 no ®no M no ❑no ❑ no
Is the Sump free of damage? 0 yes ❑yes ❑yes ❑yes ❑yes
❑no KI We ❑no Ill n/a ❑ no p Na ❑no ❑n/a ❑ no ❑ Na
Is the Sump free of water,fuel, ❑yes ❑yes ❑yes ❑yes ❑yes
and/or debris? ❑no 19 We ❑no KI n/a ❑ no ® Na ❑no ❑n/a ❑ no ❑ Na
Water,fuel and/or debris removed ❑yes ❑yes ❑yes ❑yes ❑yes
and disposed of profperl 0 no ®n/a ❑no M n/a ❑ no E Na ❑no ❑n/a ❑ no ❑ Na
Are penetrations(boots,conduits, ❑yes ❑yes ❑yes ❑yes ❑yes
etc.)into sump in good condition? ❑no 91 Na ❑no 0 n/a 1 ❑ no ® n/a ❑no ❑n/a ❑ no ❑n/a
Is primary piping interstitial space 0 yes ❑yes ❑yes ❑yes ❑yes
open,or test boots positioned,to 0 no 0 Na ❑no ®n/a ❑ no KI into ❑no 0 n/a ❑ no 0 n/a
allow product to enter sump?
Are the sensors properly positioned ❑yes ❑yes ❑yes ❑yes ❑yes
near bottom of sump? 0 no 0 n/a ❑no 13 n/a ❑ no 0 into ❑no 0 n/a ❑ no 0 n/a
If double walled sump, is ❑yes ❑yes ❑yes ❑yes ❑yes
interstitial space free of liquid? ❑no 19 Na ❑no 10 n/a ❑ no ® Na ❑no ❑n/a ❑ no ❑ Na
Results of sump inspection M Pass 0 pass M pass 0 pass 0 pass
0 fail 0 fail 0 fail O fail 0 fail
Hand Held Release Detection Equipment Inspection
❑gauge stick ❑gauge stick ❑gauge stick ❑gauge stick ❑gauge stick
Type of hand held release ❑groundwater ❑groundwater ❑groundwater ❑groundwater ❑groundwater
detection equipment bailer bailer bailer bailer bailer
❑other(specify): ❑other(specify): ❑other(specify): ❑other(specify): ❑others eci
Results of equipment 0 pass 0 pass 0 pass 0 pass 0 pass
Inspection 0 fall 0 fall 0 fall 0 fall 0 fall
Repairs Needed Date of Repair Description of any Repairs
Inspector's Signature: KUItis Wailes
ADEM Forn 19 3111 m2(revised 8/19)