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Inspection Documents for Underground Storage Tanks - Correspondence - 1 MASSACHUSETTS AVENUE 6/27/2014
da 84 Now Salem St. Ph:877.6682657 Email:infaTtcommtank,com CommObnk Wak.,Wd,MA 01880 800.628.8260 Web:wwwcommtonk.com Fax:781.224.8408 lostallatino I Maintenance I Removal June 27, 3014 Fire Prevention North Andover Fire Department 124 Main Street North Andover, MA 01845 Re: Third Party Inspection Documents— Merrimac Valley Oil, 124 Main Street, North Andover, MA Dear Fire Prevention: Enclosed for your records is the Third Party Inspection, FP-289 and FP-290 completed on June 13, 2014 at the above-referenced address. Should you require any further information on this please contact us at 617-628-8260. Sincerely, Margie Leven Administrative Assistant RX Bare/Time 06/28/2014 12,21 17812249908 'P.13d2 JUN-26-14 120815M FROV-Corimanwaalth Unk 1781224000$ 7-006 POOP F-007 Underground Sturago Tank Program Form UST FP -290 Notification for Underground Starago Tanks Regulated Under 521 CMR 9.00 Forward completed form to: Contact; LIMML • O MassDEP MassDEP Bureau of Waste Bureau of Waste Prevention UST Program Prevention UST Program A,Fadlily Number Q A.New Facility(see insttuclions,#1) (9 B.Amended B.Date Entered INSTRUCTIONS., perm FP-200 tNatlpraVan rot Uaoarafav0d 6lorano TeM)N fo ce complelsd for each location ' C,Clarks initials conlalning undargfouA*alafage talk&fagvlatod undo€$27 CMR 0,00,If mote than ova tanks aft Ownad at this location, photocopy tie(pgawing pages and ctapto eolturtuallort ahoata to the loin,The PP-200 must be cortiploled In dupfcals, Ahnouph the form may bo photoeopfca,the Iaoiityowmar orawnal's representative must sign each copy saparatolyr 0.Cammants pli0lecOcpPIOU 010ADIVIDO Are not evnfcionl,The I"pro department&tilt lsaue the permit portion of tits pp•291),Aawavof, roglatrallon Is not complete unEll the PP•200 Is laraNad and chackad by the Unuargrouna Storage Temk Program.AV gv0e1113As on ills form era to ttr+anuwcrarl,incomptato forma VAR be rolurnad. 7'Now Facllay'moans a tank ortanAs located at a s0o whole tanks have not aean pravlous?y lowtad. 2'FRci'(iy altaet mddroas'must lnelvda bola a Street number and a atleet memo,post 01Oee baN hurlbers are not --- aocaplablo and will cause a iculstrotron to be returned,if goo;raphiclocatfon of facitky to not[pX�*vlded,p[eas0 indleale dialartctt and ollacllon from closeut latarsection,a g„(fecifhy at 108 Nom stroat In loaoled)ea*vardo oouthogoc nr AAMM na Aead tinle(secllorl), Notification Raquirad substances 61mad In auoh tang,or whim welo stated In even lank berate the tank AtasapEF UST Form PP•200le to be used as NoUtic6001),Noolsiratlan,ono Palma coasod baN in opatailom If the rank won removed from bonsaih rho surface at the for und9i9latind slotoge tanko and tank reoillUes regulated under 627 Ooda of groupd prior to the submittal of suall moslca 10 the dapart*Eont.It tto ti;w was M05saeilusati5 Ha flulallom 6.00.No regulated underground sm3apo tank(oa;ily ebandenad bonaoln the audace of the grouts prior to Ito mubmktal at euctt noVice atiml 00 Intialiaa,rnolnlalned,roplaeog evbslonflslly tnedined orremoved vr[moul a to Inc dafianmwrl,ouch notice eOaU alsospeelfy,to Its extant known to Eno owner pefiro trio.20s)Issued by the WOE of tha f*aa[Oro dop*runolll,The avrper of any or operator,the date vie tanµ was abandorle*Iq Me;found and a6 molhada used 910180a loglly etiall Whin navel working days nalify,the[tend of Eno focal fire to slablltco the lank after the tank ceased Doing In oporaeon, deparment and the Oopt,of Eavifortmortis Protoetraa grapy change 10 the name, nhdraos or telephone numbef of[tie owner or oporator Ora slorego fadUty subject Cxcepttox(a)a(arm or rasldoailat tank of 1,000 gallons or lees enpsetly used roe to ran Wagon ay Onapter 144,Moot,General Law and by 627 CMR IIA0. awring motor fvel for noncommercial purposes,or ibi a lank unad for storing healing oll for conaumptive use an the promises whore sterad arm not Unrlarprcund&tempo Tonko required to be registered under 627 CfAR 9,00, Fads Owner at an unciarrifoumd Conk Ilrot put Into operation on orahef Jan.1,toot, eha%v4INn IhMY days allay the lank to Orel put Into apatatlon,trod trio a Any owner who knowingly falls to notify or avbmlts folso ihformetian shaft Pap>rtnsant of Envhonrrimlat Plotscilon(the depa"Arilt of the a staaea et suet bo sublocl to to civil penalty nor to annotI b25,0a*for each Eon%for which lank,spocffylng,is the extant known,the owner of the lank,data of 1psrapHDA, lalilleatIon In not 91von or for which raise information Is svbmlcted,10101.Chaplet cop aemy,typo,location,and uaas of stirh tank,By no lotorlban Jan.M,Seat,each 145,section 38H,627 CIVIR 0.00) owner of an undertuovno atOrogo tanµ thatwas in operottal at any litho after,tan, 1,1074,ferialdleas of whotherot not sum tank was remove*from boneal(i ma Whore to NOVO Two Completed no911callon forms should bolti be signed by the sudoco of the gioupa at any urno,Oat?itatlfy tha department of the oxfslanco of lank owner,000 copy will b4 provided to Iho fire deperimentand the tank owner aunt tank.spacllyrng,to the extsni known,the Owner of Ise tank,data or shot?land a separate COPY to the address at Ebb top of this Pogo, Inoto6adan,capacityy,type,locallon of the tank,alga ine type and quaAuty of oubelancea otored in mxh tank,or wnich word Stored in suer rank ba€Oro the lams Mon to NatlfY?i,Owners of atorago lanks in use orvtat have been[oxen out of caaaeo aaing in operation If the tank was removed rmM OOP09th trio sulfate of the operation moat nofiNwWri thirty 4Ilya, ground prior to tria 2ubminal of$Von nouee to the department.Suet Aalka shell also spedfy,to the axiom[known,the data the lonk was removed{forn beneath the Oviners and Cporalora of Reaulatod Slorago rank Syslams muot Mal main surfaco of the ground prior to the submittal otsueh notice to the dopoVeAt The rocorda eoriltylnll that allloolt detection,tnvantory control and tfghtrieoe operator of any rank that hoo no owner or whose owner Cannot be dellnlloly tasting rallttlromonts for the Rngalalod Storage Tank 6y9lorn are currant. oaeonalned,shell Redly Elva dop4drnanl of the oxletoACOOf Ouch tank,Op 00119,la Thosa rocorda must bo raaally avaltabla for(nspection, the extent Mown,any fnformalicn ralslliv to ownerahfp of the tank,and data of inma)Wlan,eopectry,I fpa,and location of the Conk,and the type and quaalfty at I.clwn0rahip of tanks IL Location of Tanks Paton Resit True, Give the geographlo location or tanks by degree,minutes,and seconds, termer&loran lcolowar n.Inal,tauel,pr 9exr,or Outer t M1Nry Fxamplo?Lat.42,3% 12'N Long,85 24,17 W 1.3 Mass achusetlsAvsnue vMAWWI m av - trng l,rdn 156111hilafall i o[W10nl from,va,leddrvsn 11111@aceam0 On rforrIticlaatinisinot en(BOB[AlWaml02) NorlhAndavbr MA 61645 MetrimaoVaguallCamtia_ny__ CRY yto zipC�. F9ak1YP7un'aarCamMnj Silaralnr&or,rucpp oota Essex 9_MIg. 11 eti6_Ayentl6 Cau'iSy -SesatAL4i,u(r' Paz nor acmple a—tau MotrwicnoW2i._. . 8713-G83.3131 t14 Siiei)343 fVoAh Andover ' MA 0.1045 Phww now t nc 6 Am Calk) 4wnara imp .r Fasord Ipa 41Y stets uP lyods Essex (.y€7J QQ'd 1508 699 91B k1#} 1 i0 As IeA 13e1111.fa8H i-V 0i- l RX Date/Time 06/28/2014 12.21 17812249908 P.003 JUII-26-14 12:07Pt1 FROM-Commanraalth Tank 1701224900E r-i1BS P.003 F-997 •"• •• wr sow.f�,.ilawl"' a ■vaaaasU a./tE Underground Storage Tan Pfagram Form UST FP- 90 Notification for Underground Storage Tanks Ra ulatod Under 527 CMR 9.00 Ill.Type of Owner IV.Indian Lands ®federal Government ©Commerolai(storage and ❑Tanks are located an land within an Indian reservatlon or on fj Slate Government sale) other trust lands !Local Government Pdv21e(slorags and use) Q Tanks are owned by native Ametican nation,tribe or individual V.Type of Facility Sol the Appropriate Facility Description: (heck all that apply) Ej Gas Station ❑Means ❑Truckingri ransporl ® Pelroreum t]lstrlbutor ❑Railroad ❑ullritlas 0Airport ©Federal-Military Q Residential ®Alroraft Owner Q Industrial [ Farm n Vehicle Doelershlp 0 contractor Q Other. tcxplorn —. VI.Contact Person in Charge orTeriks . Susan aBtlen Address; Phone Nuanbor(nclude area code) 3 Massachusetts Avenue,North 978-1357.0347 Name Andover,MA 01845 Rome President Job Tills Business,13�, VII.Financial Responsibility ❑I have met the flnanclel feaponsibllfty requirements In accordance with 627 CMR 19.Od Check all that apply: Q Sol(Insurance 0 Guerentee Q Lellor of Credit ®Commercial insurance ❑Surety Bond ©Trust Fund Q Rlsk Retention Group (]Slate Fund Q 01her Method Allowed- Explain Provide policy Information,cenlilcale of compliance informatlarl or other vorification. VIII.Environmental Site Informatlon Theis Intormallon should be avallable from local health agent,conssrvalion commission,or planning department. 1.Tank silo located in wellhead protection area ❑Yes M No 2.Tank site located In surface drinking water supply protection area ❑Yes ®No 3.`rank site Iocaled within lou tool of a wetland Q Yes 3 No 4.Wank site located wlthlrl 300 feet of a stream a water body M Yea El No IX.Dosorlption of Storage Tanks and Piping(complete for each tank at this location) Tank Idenlilleallon Number Tank No.1 Tama No.2 Tanh No,3 Tenk No. Tank No.5 1.Tank Status a.Tank mfr'a serial 0(if known) h.Currently in Use c,Tsmporarliy out of Use(start date) i d.Permanently Out of Use(start data) s e.underground Storage Tank(UST) t T U-SI UST € 2.Dale of Installation(MM1DDIMY) 1976 1976 =0 �678 3.Gatimated Total Capacity(981100) 2"00 2�.000 - LQ900 10.r300 k E00100O'd [309 689 m(m) 110 AG I I eft �oew l JGIA1 EPEE. hl-OUK/90 I E i RX Date/Time W26/2014 12:21 17812249908 P.004 JUN-26-14 12:07PM FROM-Comariweal th Tank 17812240900 T-069 P.084 f-99T .,.•„_..,v... — r„ff%1V121i1N11►N! 1 IVL4U4RA1 Underground Stbrage Tank Program Oran UST FP-290 Notification for Under round Storage Tanks Re ulatad Under527 CIVIR 9,00 Ili.Type of owner IV.Indian Lands ®Fednrdl Government [)Commercial(storage and ❑Tanks are located on land within an ind!an reservation or on ®state Government sale) othertrU51 lends iJ Local Government ❑private(atorage and use) ®Tanks are owned by native American nation,tribe or individual V.Typo of Facility Select The Appropriate Facility Description;(check all that apply) ❑Gas Station ©Marina Trur kinglTransport iI Petroleum Distributor ❑Railroad ❑Ulifitles 0 Airport d Federal-MI111ory ❑Residential ®Aircraft Owner ❑lndustrfal O.Cerm Q Vehicle Dealership iJ Contractor ❑Other: Explain VI.Contact Person in Charge of T4nks Address: -P ona Humber(include area Code) Name —. 1. Home 'f iirfl 8[!9 i�leSS VII.Pinanciat Responsibility �1111110 met the flnenclal responsibility requirements in accordance with 627 CMR 9.00 Chant ail thal apply: Self insurance ❑Guetantee 0 t.etlsr of Credit commercial insurance ©Surely Bond ❑Trust Fund Q Risk Retention Group ❑slate Fund :❑Other Malhod Allowed- tixpialn __...,. Provide policy Information,certificate of compliance Information or other verificallon, Vlll.Environmental Site Information This Information should be available from local health agent,conservation commission,of pisnnfng department. 1.Tank site located in wellhead protection area 13 Yas ❑No 2.Tank sits located In surface drinking water supply protection area Cl Yes Q No 3.Tank site located within IDD feet of a welland ❑Yes ❑No 4.Tank site located within$00 feet of a stream or water body You_Q Na IX.Description of Storage Tanks and Piping(complete for each tank at this location) Tank Identification Number Tank No.6 Tank No. Tank No.' Tank No, lank No, 1.Tank Status a.Tank mfes codal 0(if known) b,Currently in Use c.TeMporarlly Oul of use(start data) Permanently Out of Use(start data) - e.Underground Storage Tank(UST) U 2.pate of Installation(MMIDOIYYYY) 1078 l 3,Estimated Total Capacity(gallons) 2g,QOO 8 r 1, O1t+QQ'd G5(l8 s88 8L6( } I !O Aa l l eft �laew i racy(£ ;O� VI-OZ19�/30 4 RX Date/Time 06/26/2014 12121 1781224990B P.00S JUN-20-14 12107PU FROM-Coensonwealth Tank 11812240000 T-008 P.005 F-907 ^"•..�...rs.• .1 A-'.*II�11.//YIIINI 1 1 V\VY\IIII1 Underground Storage Tank Program kil Fora UST FP-290 NotlficHtlon For underground Storage Tanks Regulated Under 827 CMR 9.00 Tan ldanlifiCallon Number(cont.) Tank No.1 Tank No.2 Tank No.2 Tank No.g Tank No,5 4.Substance Currently or Last Stored a,Gasollne © ❑ J❑ motor vehicle or Other uss ❑N1V ❑Marna ❑MV ❑Marina ❑MV ❑Manna ❑MV OMarina ❑MV ❑Marina ❑Other t❑Other Q Other ❑Other ©other b,Dlesei ❑ ❑ ❑ ❑ molar vehicle or other use ❑MV ❑Marina ❑MV ❑Marina ❑MV ❑Marina QMV ❑Marra ❑MV [:]Marina ❑Other E3 Other C]other ❑Other Q other o.Kerosene ❑ [ ❑ (] ❑ d.Fuel 011' 0 Tonsumpliva Use Tanxia Head not to roolalara0, consurnptivo tlsa fuel used o><alualvefy for area haating aAdlar hot water. o.Waste Oil © 13 I.Other,Please specify i Hazardous Substance (other than 4a thru 4e above) CSRCLA name and/or CAS Number Mixture of Substances(Please specify) 5.Malarial of Construction-Tank(mark only one) Pare Steel(Includes asphalt, Q ❑ {] ❑ p galvanized and epoxy coaled) Cathodicclly protected steel i Composite(steel with fiberglass) Q ❑ ❑ Fiberglass Reinforced Plastic(FRP) ❑ ❑ ❑ ❑ ❑ Concrete ❑ ❑ o ❑ ❑ Unknown © ❑ Other Please Specify u.Type of Construction-Tank(marls only one) Single Walled 59 ® ®. Doubts Walled O ❑ 0 Unknown ❑ © ❑ O G1 I ❑they Please Speclfj Is lank lined? ❑ ❑ ❑ ❑ ❑ Dons tank hava excavation liner? ❑ ❑ ] © ❑ t I 6 �' COlSQI 'd [WO 699 016(XVJ) i l0 Ael leA VPWP-laWEV,Cl• fitLOU9�/90 i RX Date/Time 06/26/2014 12:21 17812249908 P1006 1UX-26-14 12:08PM FROM-Commonwealth Tank iT8t2249909 T-000 P.006 F-997 '•ram -1' ..1/.100 rl r #II V111111/I I%"# 1 IMGVi�t,lV11 Underground Storage'rank Program Form UST FP-290 Notification for Underground Storage Tanks Regulated Under 627 CMR 0,00 Tank Identl9callon Number(cant.) Tank No,P_ Tank No. Teak No. Tank No. Tank No. 4,Substance Cttrrenlly or Last Stored a.Gasalino D p ❑ ❑ motor vehicle at other use OMV Marine ©MV QM24na QMV--marina ❑MV ❑Marina ❑MV Marina ❑Other ❑other ❑Other ❑Other ❑Other b.Diesel ® ❑ ❑ Q ❑ motor vehicle or other use ❑MV ❑Marina ❑MV ❑Marina ❑MV []Marina ❑MV ❑Marna pMV ❑Marina ❑Other Q Other ❑Other ❑Other ❑Other a.Kerosene ❑ ❑ ❑ ❑ ❑ d,Fuel Oil' 1] Q © ❑ ❑ 'conoumpllva uoa Yanks noatl nol ba roglnlorad. 'nonsumpllye ure fuel used oxotuslrely rot area rloaling andfor Rot water. e.Waste Oil Q ❑ (] ❑ Q f.Other,Please specify He2ar0ous Substo ce (other than 4a thfu 4e abovia) CERCLA name and/or GAS Number Mixture of Substances(Please specify) 5.Material of Construction•Tank(mark only one) Bare Sleal(includes asphalt, ❑ © © ❑ ❑ galvanized and epoxy coaled) Colhadicolly protected steel ® ❑ ❑ ❑ ❑ Compuslte(steel with fibefglass) ❑ ❑ ❑ ❑ ❑ Fiberglass Reinforced Plastic(FRP) © ❑ ❑ ❑ Concrete ❑ ❑ ❑ ❑ ❑ Unknown ❑ ❑ ❑ ❑ Other Please Specify G.Type of Comtructlon•Tank(mark only one) Single Walled ❑ [[ ❑ ❑ Double Walled ❑ © ] ❑ Unknown ❑ ❑ p p ❑ Other Please Spsctfy i to lank lined? ❑ Q Q [] ❑ Does took have excavation liner? ❑ Q A ❑ ❑ I i gPCO/900'd I.K9 699 0L6(XVA I l0 491 IRA Vem l•r.1aW PP"Cl• bl-0Z/9�/90 'E ...I RX Date/Time 06/28/2014 12,.21 17812249908 P.007 JUN-26-14 1240Pti FROM-ConnonwaaIth Tank iT8122A9ti08 7-008 PAT F-097 WWZ'-E0111H1ft Vl lsElE 1{VIII IIMIILLLI1 ILJ L'GLE Lf L,111 Und rground Storegs Tank Program Form UST FP-290 Notification for Under round Storage Tanks Ro uisted Under 52i CMR 9.00 Tank Identification Number{cunt,) Tank No, Tank No,2 Tank No, Tank No.A Tank No.5 I.Material of Construction-Piping(mark only one) Bare Steel(includes asphalt, p 0 0 galvanized and epoxy coated) Calhodically protected steel Fiberglass reinforced plastic(FRP) ❑ ❑ ❑ Flexible 1❑ ❑ ❑ d ❑ Copper [) ❑ ❑ 0 ❑ unknown © [� © ❑ ❑ Other Please Specify a.Typo of Construolron-Piping(mark only "no) Singlawalled Double Walled ❑ ❑ ❑ ❑ ❑ Unknown ❑ Other Please Specify Has plping been repaired? ❑ ❑ ❑ ❑ ❑ Is piping gravlly feed? ❑ ❑ ❑ ❑ ❑ sate X.Installation Cornpllanae 9.Inslai181lon a. Installers certified by tank and plping ( ❑ [] [j Q manufacturers b.Installer Cerllfied or Licensed by the ❑ ❑ ❑ [) lmplem®nting agency 0,Inataliatlon inspected by a registered ❑ ❑ ❑ © ❑ eingineor d.Installation Inspected and approved ❑ ❑ ❑ ❑ by the implementing agency e.Manufacturers Installation rheckllals ❑ ❑ ❑ ❑ 13 have been completed F.Another method allowed by 527 CMR 9.00,Please Specify k.Tank Leak Detection Tank Tank Tank Tank Tank (mark only one) a, trouble-wall tank—InterstiUal ❑ ❑ ❑ monitoring b,Approved In-tenk Monlioring ¢� j u,Soil Vapor monitoring(check one Q ❑ ❑ ❑ ❑ below) E]Monthly []Continuous e.Other method allow®d by 527 CMR' 0.00,Pleasespecify u P l 01 00'd GSQB 68B 8L6(? Id} 110 48I 1 eA 13ew 1,1-19N Pp::U KOZ19Z190 i RX Date/Time 08126/2014 12i21 17812249908 13,008 JUN-26-14 121OPM FRbI{-Conaonwealth Tank 17012249906 T-008 P.008 F-69T Undcrgroun d Storage Tank Program Form UST FP-290 Notification for Under'round Storactlo Tanks Regulated Under 627 CMR U Tan%ldentif eatlon Number(cord.) Tank No,8 Tank No, Tank Na. Tank Na. 'rank No, 7.Material of ConstnlCtlar!-Piping(mark only one) Bare Steel(includes asphalt, ❑ ❑ © ❑ d galvanlzed and epoxy coated) Cathodically protected steel ❑ ❑ ❑ ❑ Fiberglass reinforced plastic(FRP) ❑ © ❑ ❑ ❑ Flexible ❑ ❑ ❑ i❑ Copper ❑ ❑ 0 ❑ ❑ Unknown ❑ ❑ Gj ❑ ❑ Other Please Specify 9,Type of Conslrucffon-Piping(mark only Clio) Single Walla ® ❑ ❑ ❑ Double walled rl ❑ © ❑ ❑ Unknown ❑ p ❑ ❑ ❑ Other Please Specify Has piping been repaired? ❑ ❑ ❑ ❑ ❑ Is piping gravity feed? ❑ ❑ {] ❑ Dole X.Installation Compliance 1.Installation a,lncfallero aerifked by lank and piping © © ❑ ❑ ❑ manufacturers b,Installer Certllled or Licensed by the ❑ © © ❑ Implementing agency c,Installation Inspected by a registered ❑ ❑ ❑ ❑ ❑ engineer d. Installation Inspected end approved ❑ ❑ ❑ by the Implementing agency e,Manufacturers Inelellatfon checklists ❑ ❑ ❑ ❑ ❑ have boon completed f Another method allowed by 527 CM 9.00,Please Speulfy 2.Tank Leak Qaloction Tank Tank Tank Tank Tank (mark only one) a,Double-vial]tank—interstitial © ❑ ❑ monitoring b.Approved In-tank Monitoring © ❑ ❑ ❑ c.Salt Vapor monitoring(check one ❑ [ © ❑ ❑ below) i 21 Monthly ❑Continuous e.Other method allowed by 527 CNIR 9.00. pleases ecf --,. 0/000'd GSOS 699 8!S(xvj) I 10 Aa I I eA Vew 1 AJOH S#:£G t+1 OUK/90 r ` J RX Date/Time 06/28/2014 12:21 17812249908 P.009 MI-26-14 12:09W FROM-Connonwealth tank iT6122499t18 T-608 P.469 F-997 ....... ... ... wf. ��err nuvuwl r u►uY,uur Underground Storage Tank Program lLi Form UST FP-290 Notilleation for Under round Storage Tanka Regaulatea llndur 527 CMR 9.00 Tank identification Number(cont.) Tank No.I Tank No.a Tank No-A Tank No.-4 Tank No.{ 3,Piping leak delection(mark only one) piping Piping Piping Piping Piping A.pressurized a.Interstitial space monitor ❑ ❑ ❑ ❑ b,Prodvol line took detector 13 (] p ❑ ❑ (marl(all that apply) ❑Automatic flow restrictor' ❑Aulomallc shut-off deuce° q Continuous alarm` Also raquiras annual lest of device and piping tightness test or monthly vapor monilarlog of soil. 8.8uction=Check valve at tank only ❑ ❑ ❑ ❑ ❑ (raqulres Interstitiat space monitor or line lightness lest every three years) ❑Interstitial space monitor Q Lille tightness test C. Suction:Chock valve at dispenser only (no monitor required) D.Other melhod allowed by 527 CMR 9.00,Pleases eci 4.Date of last lightness test(Ienk$plping) a,Gravity feed piping p ❑ 6.Spill containment and ovarfill protection A.Spill containment douico installed l� B.Overfill prevention device Installed 7.Daily lnvenioty Cnnlrol(mark only one) A. Manual gauging by stick and ❑ ❑ C] ❑ ❑ fecords reconciliation S. Machartleal lank gauge and records ❑ © ❑ Q ❑ recanrillation C.Automatic gauging system 8,Cathodic Prateclion(if applicable) Tank Piping Tank Piping Tank Piping Tank Piping Tank Piping A.Sacrificial enade type ❑ D B. Impressed current 0,bate of lost test Date of last third party Inspection(MM10DiYYYY)8113114 X1.Ci:rlification (read And sign after completing all sections) NO r G,aoln ilia copy oelng sans to inn nopt-of Fnvllonmeniar Arolaetiort and the copy lnrwatded 10 the local pre depallMnt must be signed separately,A pnolocoprad bJuwlruro VAI not lie acceptaa on Other daevntattt. i declare unoer papally of penury that I havo paisanaiy axe ne and arrt mid car wdh thm a orme art supra ea in tni9 anti sa auaeriad oWUMNIts,a Vial wail on my ingviry of thoue ksgivlduais Immediately raaponoiblo for ablainma the rnknmoden,1 bellow ttlnt 1he submtlled informaffon is vue,sccurele,and COmpt M No sc and etna a! f owner's euthorrzad re roaentnnva ogle C)(fIC191 TIIIe SUnaa ure I � �rsao' l sae see s�s(xv�3 1 !a AG I I RA 132tu I A-19H 9t;:61. f: IDUOzr90 I RX Da Le/Time 06126/2014 12121 17812249908 M10 Jtlli-26-14 12:09PA FRO,+Commanwealth Tank 11012249008 T-008 P.010 F-297 Underground S#arage Wank Program Form UST FP -290 Notification for Under round Storacial Tanks lZe utated Under 627.CMR 9.00 'Tank Identification Number(cons.) Tank No,¢ Tank No, Tank No. Tank No, rank No. 3•Piping leak detection(mark only one) Piping Piping Plping lalping Piping A,Pressurized a.Interatillal space monitor ❑ ❑ ❑ ❑ ❑ 11.Product line look detector 11 ( ❑ ❑ (mark all that apply) C-) ®Automatic Oaw restriclor" ❑Automatic shut-off device ❑Continuous alarm* a Also requires annual test of davlee and piping tightness test or monthly vapor monitoring of soil, 8,Suction;Check valve at tank only 0 C} ❑ [] ❑ (requires i11ier8111181 space monitor or line tightness test every three yea(s) ®interstitial space monitor ®Line lightness lest C.Suctlow Check valve at dispenser only (] ❑ © ❑ (no monitor required) D.Other molhod allowed by 527 CMR 9.00,Pitaasa spec!fy 4.Date of last tightness lest(tank Aplping) 5.Gravity feed piping Q ❑ ❑ Q 0 8,Spill containment and overf111 prolection A.Spill containment device Installed 99 © ❑ ❑ ❑ l3,Overfill prevention device Installed ® ❑ ❑ Q ❑ 7.Daily Inventory Control(mark only one) A. Manual gauging by stick and 0 ❑ ❑ ❑ ❑ tacnrds reconc)llatlon Q. Mechanical tank gauge and words Q ❑ ❑ © ❑ reconclliation C.Automatic gauging system ® © © Ll ❑ 8.Galhodto Protection(if Oppllcable) Tank Piping Tank Piping Tank Piping Tank Piping Tank Piping A. Sacrificial anode typo Q ❑ ❑ ❑ ❑ - ❑ Q ❑ ❑ ❑ B. Impressed currant ® K 0 ❑ ❑ 0 ❑ © ❑ ❑ C.dale orlast tesl Cate of Iasi third party Inspoelion(MM1p13/YYYY) 2L1.21 a XI.Certification(read and sign after completing all sections) ROM DOtn rna copy bola tans to the Dopl,at Ifnvrrnmmnnrar PraraetiaA and the Copy larwardad to tha loael rite Uepanmanl muss ba olanad aaparatety.A pholocoptad blonalgra tilt not be accepted on elrhordDwmenl, 1 gectarti u er erlally at pafury that Nava pereaw[ry eaam�ina anq om fomnrerwl l e n ormstfan svbmuts n e and ee nnecnen oeulitonta,on oral base on my Inquiry ar hose�ndividuala Imrncsrdwely raspansiblo for wainlno the lnlarmatlon,I booeve that rho oubmh1od rararmaaan is vue,accurate,and eMplate• Mama arW offtelal Ihla of ownor's aLdharIzed to reoontallvo r fQama fllc al Tlllo 5f9nalifia pate y 0�'Q10'd M9 M gL6(M) 1 !U hat IRA VRWl,I.laNWCl• V 0• 19�/90 .a PX bate/Time 06/25/2014 12:21 17 y224g3DS P.011 JUN-26-14 12:tON FROM-Commonwealth Tank 17912249908 T-OO8 P.011 f-997 Underground StDrago Tank ProgramId -. -.. Form UST FP-289 Third Party Underground Storage Wank Inspection Instructions:This form shell he cMtptelad by n Third•Perly Inspector as defined by 527 CMR 9.02 and In corapllance with 627 CMR 9.071p) � a Faclilly Name: Merrimac Valley Oil co, DEP Facility ID Number: 10705 Raqufrea Can bo rooked up atr hft : db. fate a srde Justrus ug a e.on Street Address(no P.O.Box): 3 Massachusetts Avenue City; Nonh Andover State. MA ZIp; 01$45 Counly; Essex Phone Number at Facility: 978.683-3131 Oporatvr Informatiop . Name: Tom MarRtevilz Title: Dome Phone; - - Fax: 978 QBg-8051 Address: 3 Massachusetts Avenue City: North Andover State: MA 21p: 01845 Owner lnforrrlation Owner Name: PATaB Realty Trust Address: 1-3 Massachusetls Avenue city: North Andover State, MA ZIP: 01645 county; Essex Phone Number: 978-683-3131 Fax; 978.683-8051 E-mail: Federal Ernployam IDHl 04r6500343 i i 3 •' Questioln?Contact the MnssUEP office at phone:tie 7-5$6-1063 Also ehecic the PP-289 VAQ at tltt :/lwww �1as. nv/de !ip%loslu5r/ 1 1 1 1 Inspector's Initials: Ow rlQAaralors In t ale: Dale: - /Y Date, PP-289(Itev 7124/2012)-Pasc 1 f 11O'd LH9 689 916(Xilj) 110 49112A A3en1a-191A1ZV:CL PLOU9V90 Rk Da teM me 06/2612014 12:21 17812249908 P.012 JUli-26-14 12a10P11 FROV-Coanonwealth Tank 170122482OR T-00B P.012 F-99T Inspeetion 17a1e:.- 5113l14 Inspector Name• Luls A.Diaz Inspector Company: CommTank,Inc. —w lIAspeclortDNi 1083 Address: 84 New 0aslcm Strew City., Wakefield State: MA Zip: 01880 Phone: 617-628-8260 (Work) Qualification: State Approved Third party Inspector 817-A9a-70z0 Mabrl Is!alcense io slots ilammab eslco tsustibles osted on site Form t p-2? yes No NA Is a current certificate of fe lstration posted on site Form F-P-5? Yes No NA Is a currant emit to maintain USTs posted on site(Form F-P-290 art 3? Yas Np Is the Currant Fo P•290 accurate?Sea. 1.A R 2.A..mustmorch the FP-290 Yes No Is financial res onsibllli ve ified7 YaW Vert Ihat g &C O sisters have aaen t toed, e Attach most recent Form FP•290 At Fill out the tanlc number for each tank using the DPS tank numbersystem found on the FP-280. Use a second Form for facilities with more then 4 tanks. e . e T11e1 Number of Tanks on She; 8 Tank No, 1 Tank No.2 Tonle No.3 Tank Ov,ner Tank 4 Tank Serlal4 Geographic l.ocallon of Tanks-Laliiuds; 71,08,40.07 W 71.08,40,07 W 71,08,40,07 W 71,08,40.07 W Gaogrophio Locallon of Tanks--Longitude: 42,41,54.15 N L 42,41,54.15 N 42.41,54.15 N 42,41,54.15 N llae dogroes,minutes and seconds. Fxsmptes. tat.Q,35, 72 N tong.6A 24,17W Slatus: to uaa ra usa ®IA use 8 In U18 ff out ofuse, complete2.8. PTompo,noruou ❑'rempebfusa ©Tea,p aid ofUsa ©Tornpoutaluse Perm a unit Palm ou�t of uaa. Q Petit Out a 11ae M Form Out of Uae Total Capacity of7anfc:(gel.) 20,000 20,000 2D,000 20,000 Is tank a split(compart Ment)lank? Q Yes ®No ©Yes R No ©Yas ®No ❑Yea IN No Capacity of each compartment,(gel.) For,9a.nnn ar rank snow aoMaoo _ Tank Conlerlts 1 Producl: rat aprlrranh snowprs awt Na,21 usl t71! Na 2 Fuel QI[ No,2 Fuel Oil Na.2 Fuel Oil asnUn a Sane rnsamaaruerasraatent Roes lank contain gasoline andlor diesel? ❑Gasoline ©Gasollna ❑Gasoline Cl Gasoline rn porror,vAa;a orienk icompedmenred)faranypon orQ016 nr me sraar.� Q Diesel El Diesel ❑glassl ❑Dlaset It yes,for toad use or for me tine fueling? ' Road Use Q Road Use head Use Q Road Use t aavo 6lonkllotri. Marina D Marine ©Marine ❑Marine Used for ame roan cy power generator ❑Yes ®No [3 Yes IN No Yes ®No p Yes ®No ! Tank Construction Material Sisal Steel Slsel Steel I I Tank Wall Type: Single nr Double sw p DW ®SW Q DW'' (MEW p ow ®sw p ow a Pipe Constructlon Matariel steel steel Steel Sleet Pipe wall Type: Single of Double [K SW ❑ow maw Clow 'EM sW ❑OW ®aw Q DW t Multiple Runs Per Tank,tl yes show on map ❑Yes 0 No p Q Yes ®ND Q Yea ®ND Q Yes ®No ltlspactor 6 InHlais: /1 OwnerlOperaroes initials: { toots: , ZG -(�,y Date,/ -r� FP-289(Rev 7/2412012)-Page 2 w •L�d fC d G5178 689 8L6{Xtl�} I IO del ie �ewi_t�eW� :Oi Vl06/9z790 RX Date/Time 06126/2014 12:21 17812249906 R,013 JUN-26-14 12:11PM FROVKoanonwealth Tank 17811249009 T-008 P.013 F-29r -Inspeclion Rate: fnspectorNamo: Inspector Company: inspector 04 Address: City: Slate: Zip., Phone,, fluellflcsllon: MCbii e Is a I€tense to store tlHnlmable&leamptratib ss ofilad on site Fn FP-2? as No N Is a errant certifrcata of re isiratlan oslad Cn site Farm F -5 Yes Na N Is a aurrorit�eI�tD mainlyln 115Ts posted on sire Farm l=P-2 30 srt 3? Yes No is the ctlrrtant Form FP•2flta Hccurato7 5eo, i.A$2.A..must match the PP-290 ❑you a Is financial res ons€blllt verlfled7 Yes No VorIfV that A 13 &C O erators have been trained, Yes No Attach most recent Form FP-290 itached Fill out the Yank number far each tank using the DF5 tank number system found on the PP-290- Use a second form for facilities with more than 4 tanks. Total Number of Tetnks an Site: Tank No,5 Tank No,r3 Tank No, Tank No. OwnerTnnk# Tonk 5srial# GeDgrap€rlC Location of Tanks-Latitude: 71,O8,40,07 W 71,08,40.07 W (aoogrophlc LaC9llon of Tanks—Longitude: 42,41,54.15 NA 42,41,54.1 t7 N Uav degrees,minulas and seconds. Examples. Lat.42,J8, 12 N Long,85,24,17 W 61atus: 29 In We ED In use In Use In usn if Out aFus@,complete E.S. ©Tamp oul of We 0 romp elitat rise Tamp out of Use 0 Temp out Of use 0ParmoulolU10 Par aylpfuBo Parm2gJaLUse Q Perm Out ofure Tula]Capacity of Tank.(gal.) MOOD 20,000 Is tank a split(compartment)tank? ❑Yes ®No ©Yes 0 No ❑Yes ❑No ❑Yes ❑No Capadty o each CCrnparIfnent:(081.) FaraIQOaa alraakshow860"M Tank Conlenla i Product: Forapfnraak show producr Nu.2 Fuel09 Diesel asolfaeOrarosa aIn Bo a orat Own(olli Does tank contain gasollne andlor diesel? Gasoline ❑Gasoline g Gasoline ❑Gasoline fnparlarlvho)O40tonlr frompa(emantou)for anywfQrwhvly Riegel ®Diesel I,,!QI>'9el ©[7i9Se1 _nf15n ear. if yes,for road Ilse or for marine fueling? : ❑Road Use ®Road Use ❑Road Use ❑Road Use Loan bebnrcxerher p Marine ❑Marine ❑Marine ❑Marine Used for emergency power generator- ❑Yes ®No ❑Yes N No ❑Yes ❑No ©Yes ❑No Tank Cons truclion Material Steel stoat T anit Wall Typm Single or Double SW a 12W ®6W ❑DW" ❑sW 0 DW ❑8W ❑DW 0 Pipe Construction Material steal Steel a Pipe Wall Typo: Single or Rouble SW ❑OW ®SW ❑DW ❑5W ❑DW ❑SW ❑OW a Mulliple Runs Per Tank,Ityas show on map ❑Yes ❑No ❑Yes ❑No ❑Yes [INo ❑Yes ❑No e Inspacloer.In11IaIB: Ownerloperaloes Initial*: guts: Oate: 1 17P.1)RO(Rev 7/21412012)-Pnge 2 ___-. 116 h@I IPA �13eulIJ.,IeNOV:01 VLOZ/9Z190 RX Date/Tiitte 06126/2014 12t21 17812249908 P,014 Jll[I-26-14 12:11PA FROM-ConnanwaaIth Tank 17eI2249909 T-OOB P-014 P-99T Tank No.1 Tank Na,2 Tarok No.3 Tenn No,A If yag>proceed to section: Automa tic Tank Gsualno(ATM ® ® ® ® 3,A, Continuous in-Tank Leak 0sleet SyslamCLOS) ❑ n 3.e, Interstitial Monitoring(IM) © ❑ ❑ ❑ 3 c Inventory Con1roll8tat slicat inventory G7 ❑ ❑ ReconctliaWn SiR ❑ 3 p. Other (EXPLAIN) 1 lie antira piping system Must Moot the standard,including split pipes. For piping systems that have been parltally replaced,the Inspe0on report must be completed for the least complionVoldest sections of pipe, Pipa numbers on skotch In 2.C.correspontt with pipellank number below. " No.1 Tank Na.2 Tank No,3 Tank No,4 fYas.proceed Tank Pressurized piping only to auction: Automatic tine leak detector(3 gph)Si double•arail pipe with liquid sump sensor or [( d L7 ❑ 3,c,quo a,o. With manual Inlen:tllial Monitoring ALLD(3 gph)8 annual'line tightness test ❑ 13 ❑' ❑ 3" e.nNa 3.e, AL-i,D that can perform 3 gph continuous lus Q.2 1t/monlh e[eclranic} ❑ ❑ ❑ 3.0, 01har (EXPLAIN) suction piping only Imerslilial monitoring d ❑ p ❑ 3 a Poriodin Tightness Testing(non- European) ❑ © Q ❑ 3,E. Eurnpeon Suction ® ® ® 3,P. Other (EXPLAIN) • . Tank No.1 Tank No.2 Tank No,3 Tank No,4 If yes,proceed to section: Galva nle Calhodfo Pralectlon(GC)Tenk and/or Pi (fl ❑ ❑ ❑ ❑ S.A. Impressed Current (IC)Tank and/or Plain- ® a ® am. Non•nnralat Piping(NM)Tank AND Piping Whole system trust he non-metal to ❑ ❑ ❑ 5.0. —complete this section, t]lher (EXPLAIN) Fill out this seallan for any lank that le"temporarily closed"(conlafns product bul Is out of SON[da)or is 4oken out of service"(empty and out of service).A complete Inspeol[on of these Ranks Is required, Note: This section does not apply to a lank that Is currently in use or permanently closed w/rh]n S27 CMR 9. i ® Tank No, Tank No. Tank No. Tank No, Tank contains less(lion one Inch of product Cl Yas ®No ©Yes ❑No Q;Yes [3No ❑Yes ❑No I —Al pipe locket-ar secured to prevent access ❑Yes ❑No ❑Yes ❑No ©Yes Q No ❑Yes (3 No Leto tank was`Vmporarty closed'(Man ad Verify max time for ramp out of service: Single Wail Tanks-6 months t❑Yes ❑No ❑Yes ❑No ❑Yes Q No Q Yes ❑No Double Wall Ta s-24 months Fire Department Permit Posted ❑Yes Q No ❑Yes ❑No Yes ©No ❑Yes (I No �If tAnk fs permanently closed,Is FP- 99OR on tile? []Yes ❑No p Yea (:]No M Yes ❑No ❑Yes C)No Ins actors Initials: - P ® ownerltJperalnr`s Initisla, ©era: lx 1Y Data: f, i PP-289(Rev 7/24/2O12)-('age 3 fie 2 3Ewl.t.l2 �:�LIhl.O'd 15Q8 6B9 8LB(Xtl�3 I .4 [ I A � Ni 0:SG 'b1.0MV9I3 RX Date/Time 06126/2014 12:21 17812249908 � P.o15 .JUN-26-14 12;11N1t FR04t-Cosncrtwealth Tank 17812240000 T-000 PAIS I:-997 Tank No.5 Tank No.6 Tank No,' Tank No. If ysaprocwrd to sea#lon: Autcroslly Tank Gauging!!(B!! �{ ® ❑. • ❑ tos Continuous In-Tank teak Detect System CLDS) © ❑ ❑ Interstitial Monitcring(IM) ❑ ❑ ❑ : ❑ U. Inventory Control/S1allstlul inventory Keconcilialtal 81R ❑ CI ❑ ' ❑ 3.o. ether (EXPLAIN) 'Pie entire piping system must meet the standard,Including spill pipes. For paprnp systemo that have been partially replaced,the Inspection report must be completed for the least cornpiiant/oldast sections of prpa, Pipe numbers on sketch In 2.C,corrospond wilh pipollank numbarbelow, " Tank Na.5 Tank No.6 Tank No, Tank No. Ifyas,proceed Presaurized piping only to acction: Automatic line leak detector(3 gph)a double•wai(pipe with liquid sump sensor or. ❑ © i:7 ❑ 3.c.AND 3.0. wllh.manual interstitial,Monitoring ALLD(3 gph)&annual 11no tightness lest ❑ [) ❑ ❑ 3.E.AND 3.0, ALLD that can perform 3 sph continuous © ❑ plus 0,2 gphfmonth electronic) ❑ © s.�- Other (EXPLAIN) Suction piping only Interstitial monitoring ❑ © ❑ ❑ 3.n, Periodic Tightness Testing(non- ❑ ❑ Cure eon)_ © © 3,e. European Suction ® ® ❑ ❑ 3.F. Other (ExPLAM) Tank No.6 Tank No.6 Tank No. Tank No. I ifyes,proceed to section: Geivanlc Cnihtdic Protection(GC)Tan11, ❑ ❑ ❑ © S.A. Pi to Impressed Current (IC)Tank and/or pi © Ca. Ling Non-Melaf Piping(Niel)Tank AND Piping Whole system must be non-metal la (] [J ❑ ❑ 9.c, com Iota this section. 0111er (EXPLAIN) rill out this section for any tank that Is'temporarily closed"(contains product but 13 out of service)or Is"laken cut of service,,(empty and out of servlc®).A complete inspection of these tanks is required. Not®: This section dales not apply 10 a teak that Is currently In ono or permanently closed within 527 CMR 9. e , , Tank No. Wank No. Tonk No. Tank No. Tank conlairts less than one inch of product ❑Yes C7 No ❑Yes C1 No ❑Yes ❑No ❑Yes ❑No Fill pipe tacked or secured to prevent acceaa ❑Yes ❑No ❑Yes ❑No ©You ❑No 0 Yes ❑No Dais tank%vas'Wnrpn"cloM'fMolth1Year) i Vorify max time for Tamp Out of Service: . Single Wall Tanks-6 months (]Yes ❑No ❑Yes 0 No - ❑Yes ❑No ❑Yes Q No Double Wall Tanks-24 months Fire Department Permit Posted ❑Yes ❑No ❑Yes CJ No ❑Yes ❑No ❑Yes ❑No if tank 1s permanently closed,is PP•29J}R on file? ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No inspector's Initial$:14 Owner/Operator's Inilials: P Date: � - Z 6••ry - - Hate. r PP-2)89(Rev 709412012)•Page 3 o • __ 2COM0'd l549 609 916(m) 1 (0 A91 tart KOZ/9Z/90 RX Date!me 06/26/2014 12.,21 17812249908 P,t716 JUN-26-14 12:12PM FROM-Comonwealth Tank 17012249000 7-000 P•016 F-SOT Far SpiitlComparimented tanks label sections separately(for example 1A&4B). Q O (p) Q o 20,000 20, galoh 9. w 10,000 opyml .9 O O 20,000 141 0 a o o O 20 000 �a� : p tdrq� (g) (D) O o O 20,000 Im ® Vertical Anode n� O LJ ,)xutWn DOIA O fospectoi's Initials. Owner/Operator's Initials; z ) Data; � Dow Ip�Pn�-!� j FP-209(Rov 71M-O 12)-Page,4 p a — Of914'd 1.509 699 m(mj) PLOUK/90 kX Date/Time 05126/2014 12:21 17812249908 ' P.017 JUH-28-14 12-02Ptt FROM-ConaonwaaIth tank 17812249008 7-008 P.011, F-90t flank No, t Tank No.2 Tank No,3 Tank No.4 1 Console Make and Model nt aeder Root MEW ROW TLS 350 TLS-35D TES-fir.o Veadaj Raot YLS.35D 2 Probe Type Model.Fill out for each lank Veeder ROOT V49dar Roat Vooder Root Veadar Raa agna1,r Ma nellc Probe Magnetic Probe- Ma !tells Prn1,e Probe Frequency.HcwraP�ndaesATGpedormtesl7 3 Continual Stafistioal took Defection(Daily) ©Daily ©Daily ©pally Daily Slv Hourin•7ank Test Monthl ®Monthly 0 Monthly ®MonlhEy !Monthly Device is calibrated,opetoled,and A malnlained per manufacturer's Inatructions ®Yes Q No ®Yes ❑No • ®Yes ❑No ®Yea Q No �, ofsaitxechsdrq efcJ. System setup raviawed. Proper settings 5 were confirmed and are correct.Verification ®Yes Q No ®Yes ❑No.*. ®Yes ❑No ®Yes L No that all probes are functioning. G Monitoring panel a control box Is present and working. 0 Yes ❑No Byes ❑No ®Yes Q No 23 Yes Q No Tank Is tilled In proper capacity and test run for plaper durallon of Ilma during the last 2 ®Yes ❑No Yes ©No •®Yes ©No Yes ©No Months,In accordance urith manufacturer's ❑Now Tanis ❑New'tank Q New Wank 0 New Tank Instructions, a manual far consols and probes 1s avail 19 Yes ❑No ®Yea ©No ®Yes [3 No ®Yes _ available at the she. ❑No 9 Variticallon that console and probe are third• party approved, H Yes ❑No ®Yes ❑No Yes Q No ®Yes ❑No ATG meals minimum performance standards, 10 wish the probability ofdeteallon set at 0.9.5%slid ®Yes (8)No Yes Lj No LM Yes ©No ®Yee ©No filB Probability of false alarm set at 0,05% 11 Existing release detection results show no Q Yes ®No ©Yes 99 Na evidenceof a release, :i7 Yes ®too Yes No ATt�Is checking the portlon of the tank that 12 rautlnsly contains product,In accordance Yes ❑No 0 Yes Q No: ®Yes Q No ®Yes ❑No with manufaclurer's Instructions. Monthly release detection records erg available for last 12 monists. ATG records roust show that 13 9 of the past 12 months have a passing last, Yes ®No Yes ®No:. Yes No ❑Yes ®No %Ahoul 2 consecutive months of Inconclusive New Tank New Tank New Tank ©New Tank results. 14 Number of Passing Menthe Pass l�Fail (�Pass ®Fall 0 Pass ®Fail ❑Pass ®Fell If tho answer to any questlon Is No,please eyptato below.List any problerns noted during fnspaerlon.NOW eorrootlans on sddandurrt. 012f IEfiICtEB: FlmTKR RaCQM1AG roAtt4N9; Inspector's InItlals: Om Ownar/Operator's Initials: . n ! t3rrle; •P : 1 S- Date: 3 l� lSt PP-290(Rev 7/24)2012).Page 5 B z t :CQJLt O,d 1Saa nq 816(m) 116 Aa 1 12A 1Oewl AJaN O9:Cl. f LU/9UGO I RX Date/Time 06/26/2014 12;21 17812249908 P,018 JUN-26-14 I2:13P1t FROM-Commonwoo lth Tanis 17012249000 T-000 PAIII P-007 Tank No,5 7,9 No.6 Tank No. Tank No. 1 Console Make and Model Veedar ROeIder Root TLE-35o TLS-350 2 Probe Type Model.FI11 out foreeeh tank Vacdar Rool Veader Real Ma etle Pubs Ma netlo Probe Frequency:ftalloQando�ATGparfamltest? 3 Continual Stoffsffoaf Losir Dafacffor (Daily) 0 Daily ©Daily ❑Daily Q Daily Six Hourin-rank Test Manthf ®Monthly N Monthly ❑Monthly ❑Monthly Dovice Is callbfated,operated,and, d maintained per manufacturer's Instructions ®Yes (:3 No Yes p No '©Yes ❑No ❑Yes 0 No PT exa �t arsernce cheeks etc}. - System Cutup ravlewad. Propersettings 5 were confirrried and are correct.Vedliicatlon ®Yes ❑No ®Yes ❑No ❑Yes Q No ❑Yes C No lhQt all ptobas era funetionln . Monitoring panel or control box Is presort[ Byes ONO (@ Yes ❑No p Yes ©No p Yes ❑No and working. Tank 16 fillad to proper capacity and test run 7 for proper durellon of time during the last 2 ®Yes ❑No ®Yes ©No M Yes ©No ❑Yes C]No months,in accordance with manutacluter's ©New Tank ❑Now Tank I]New TanK ©New Tank instructions. ■: 8 Owner's manual for console and prabe9 Is available at the site. ®Yes ONO N Yes ❑No 11 You b No ElYes 0 No rJ Varlfic aft approved. that Console and probe we third- ®Yes [:]No N Yes ❑No ❑Yes ❑No ❑Yes ❑No ATG tricots minimum performance standards, 10 will}tho probability of detection set at 0,95%and Yes ©No Yes ©No ❑Yes ❑No ❑Yes ❑No _ the pmbablilv of false alarm set at 0.05% t 1 Existing or a release, release ease,alaction results show,no evidence � ❑ ©Yea 0 No ©You ®No • Yes ❑No Yes ©No ev ATG Is checking lire portion of the tank that 12 routinely contains product,In accordance M Yaa O No ®Yes U No Q Yes M No ❑Yes 0 No VA11 manuracturer's Instructions. Monlhfy re ease detection records ars avails le for last 12 manihs. ATG records must show that ®yes 0 Na ®Yoe ❑Na ❑Yes ❑No Yes [I No 10 6 of the past 12 months have a passing test, Q New Tank [�New Tank ❑New lank El Now Tank wilhoul 2 con3ec4gve months of Inconclusive results. 14 1 Number of Passing Months ❑Posa 0 Fai1 ❑Pass ®Fall ❑.pass Q Fail j d Pass Q Fell fr the ansWof to any question Is No,praace explain below.Uat dny problems noted during Inspection.Nola corrections on adrrendum. ��161F7�IF�: f:ufkTHM REcompaNaA-noNs: inspectors Initials: Owneriopsmto?s Initials:�! t7ata: Date: �- )I RP 289(Rev 7124l2012)-page s i i y.Cg191-O'd [509 699 816(XVJ) 110 AG leil VRwlaaeyllS Ef KOZd9Z/90 RX Date/Time 08/26/2014 12:21 178.12249908 P,018 JUI-26-14 12:13PM FRO-CaRmanuaaIth Tank 17E112249206 7-000 P,019 F-217 Tank No. Tank No, Tank No. sank Na. 1 Console Make and Model 2 Probe Model.Fill in for each lank. Device ID callhraled ,operated,and 3 malntainod per manufacturer's Instructions (aaeampb;frrrgvafgofsmica wc�D,etc)Incuft ❑Yes Q No ❑Yes No. ❑Yes ©No lirnWonsfisiedoneY4monsurnmary, ❑Yes ❑No SYstem setup reviewed, 4 Proper seltings were confirmed and ore correct. ©Yes ❑No ❑Yes ©No ' I ]Yes Q No ©Yes ❑No verificatlan that all probes are functlonlna. Monitoring panel or control box is present and working. ❑Yea ❑Na ©Yas ©No O Yes ❑No ❑Yes ❑No 6 Owners manual for consols and probes Is available at site. Q Yes Q No ❑Yes ❑No ❑Yes ON[) ©Yes Q No 7 Verify that consele and probe are Ihird•party Cj Yes ❑No (�Yes ❑No a rnuad. ❑Yes ❑No ❑Yes ❑No Cl.DS meets minimum performance 0 standards,with the probability of detection p Yea ❑No ❑Yes ❑No 'C7 Yes ❑No ❑Yes ❑Na set at 0.05%and the probability of false _ alarm set at 0,05% 9 ESxisling release detec[on results show no evidence of a release. ❑Yes ❑No ❑Yes ❑No 01 Yes 0 No ©Yes [j No OLDS is checking the portion of the tank al 1i1 roullnely contains roducl,in accordance Q Yes ©No Q Yes ❑No'- ©Yes ❑No ❑Yes ©No with manufaclufer s trtstruetlons. Monthly release detection records are avalt show for tact 12 months. 2 mo records Yes ❑No Q Yes ❑No. .©Yes Q No ❑Yes 0 No 11 must sltau that B of the p8at i2 morilits have New lank New Tank a passing lest,without two consecutive ❑New Tank ❑New Tank months of InconcW slue results. 12 Number of Passing Months ❑Pass_ []Fall Pass 0 Fait ❑Pass ©Fall El Pass Q Fail rf rlrs answer to any question is No,please eaplela below.Usrany problems nosed during f'lfspecflan.Not9 CD►rocBorts on addendum. D�rcreriars: . FunmssrtRt cnr�alsrrort�oNs; Inspacioes Initials: OwnerlDperators Initlels: """ti],1 Date: Oate: i I FP-289(Rev 7/24ri012).Page 6 V �;P'O16I.0'd 1,309 699 916(kvd) 110 A@I IRA )I3ew1aaal Z9:C. tLU/9Z/90 I kX Date/Time 06/26/2014 12121 17812249908 P.020 SUN-2ti-14 120011. FROWConrianwAalth Tank 17012249909 T-009 P.020 F-997 ' Tank No, Tank No. Tank No. Tank Na. 71intersti at space is filled With II uld Brino or as 136ne ❑pry ❑brine 0 Dry t]Hrine ❑pry ❑Brine ©Dry Type of lnterstltial sensor. Q Liquid ❑Liquid ❑Ligedd ©Liquid (Le.,Liquid,01sCrIminating,Pressure) ❑Dtscrimtnating ❑01 crImIrnagng Discriminating ❑Disettminsitng L1 Pfemurs p Pressure p Pressure ❑Preissule 3 Console make and mode: n Sensorrnalre and model 5 Monitoring cnrlsala is operational. �J Yes ❑No ❑Yes Q No. ❑Yes Q Nq p Yes ❑Na B Intaratlllai sensor visually inspected, functiona11 tested and co firmed o eralional. Q Yes Q No ❑Yes ❑No ❑Yes ❑No Q Yes C]No 7 Sensor a monitors the Interstitial space in the ©Yes ❑No ❑Yes p No Yes p Iva ro riate Position. Q Yes ❑No Device is calibrated,oporaled:and 8 maintained per manufacturer's Instructions, p Yes q No ❑Yes ❑No (]Yes ❑No ❑Yes ❑No 2Mtr orseNW mema ete h Tanks Sump Is clean and free of debris Qnd Waite . L1 Yea p No ©Yes ❑No.. ©Yes 0 No Yes M No Monlhly release defecilon records are Available for last 12 months. Intemiltial 10 monitoring must show that a of the past 12 ❑Yes ❑No Q Yes ❑No.. :❑Yes ©No ❑Yes ❑No rnonths have passed with no more than two ❑New Tank ❑New Tank []Now Tank Q Now Tank Inconclusive records, 1 Number of passing months: e ❑Pass Q Fail Q P9s6 Q Fali 0 Pass ❑Fail Q Pass Q 1=a11 It the answer fa airy question Is No,please explain 6eraw.l..rst any problern$nand durInginspavlon.Nate corrections en addendum. nEFlt±?�IGIES: . . . FuRr'rf�tl�cou�titetvtan�ion°s: . Inspector's ttittiaisj1 Owner/Operator's initials:JGVI� Data, t Date: 1f � 2 G••i t1 I. .�1._�"/ �r-sav(Rev In--ono 12)-Page 7 t�11?Zp'c► i309 699 m(w) 110 Aa l I RA VRW I J-IaW ES'CL VLOZ/9z/90 RX Date/Time 06/28/2014 12i21 17812249906 P,021 JUII.20-14 12:14PM FROM-Conmunwealth Tank IT012249908 T-008 P.021 F-991 Wank No. Tank No. Tank No., Tank No. Method Name; !7a!� ! sera raco de daU when a erattn , Q Yes ❑No [;]Yes ❑No ❑Yes �]Na [I Yes ❑Na ry fecnrde ere rQconclisd man[hly, Q Yes ❑NO [J Yes ©Na ❑Yes [�No riate calibration chart is uscd for ❑Yes ❑No vOtuma to nearest 1/a 1nca1. ❑Yes ❑No ❑Yes [)No Q Yes ❑NaQ Yes (]No eadings erg fogged before each . ❑Yes a No ❑Ya9 ❑NO [[Yes ❑No ❑Yes [J No adings are lopgad after each _ delivery, ❑Yes ❑No ❑Yes ❑No Q Yes o No ❑Yes Q No Gau(te stick Is marked to deiermina product !oval to the nearest 118 Inch. ❑yes Q No ❑Yes ❑No []yes ❑No ❑yes ❑No e Gauge 611ck con measure to full height of lank. Cl Yes ❑ No 0 Yas 13 Na ❑Yes CI No Q Yes 0 No Monlhly vaalorreadings checked to the nearest B 1/a Inch and used to calculate Invenlary..Det'iaianeles.' []Ye 13No ❑Yes []No balances.If waterintfuslon Is noted,list in s ❑Yes ElNo ❑yes ❑No 1 10 F€tI drop-tube is installed and fund onal. ❑Yes [)No L3 Yes C3 No Yes ❑No ❑Yes ©No Each dispenser is materad and recorded 11 within slate or local standards for meter ❑Yes Q No Yes ❑No ❑Yes ❑No ❑Yes Q No calibration. 12 Date meter calibrated: Total monthly averages[or shoriages)are 13 less than 130 gallons plus one percent of tanks flow-through(axles)volume for the lest Q Yes ❑No ©Yes ❑No [)Yes Q No (]Yes ©No 12 months. 14 SIR read is received by owner from von or ©Yea ❑Na wllhln 30 da s of soh ittal of afore. 0 Yea 0 No 0 Yes ❑No ❑Yes []No 15 SIR results Indicate sufflctattl amount of data was used to Parfoyn look check. ©Yes ❑No ❑Yee ©No 0 yes ❑140 Q Yes ❑No 15 Existing►eieass detection tesulls In cats (]Yes ❑No n oraiion wlthout evide ce of a release. Q Yes ❑No ❑Yes [Q No ❑Yas d No Monthly release delaction records are available for the last 12 months. Monitoring 1 T must show that sight of the past 12 months ❑Yes ©No Yes ❑No 0 Yes ©No ❑Yes ❑No have a psssing record,with no more than two ©New Tank [)New Tank 0 Now Tank ❑New Tank consecutive months of Inconclusive results.if N0 re on Leak to MassDEP. 1s Number of passing months: ❑Pass Q Fail L�!Pass ❑Ealt ©Pass []Fall t❑Pass ❑Fall It the nnswpr to any Qtlastrap Is No,preeso ezprafrt 4t:raw.Lis any Aro6rdRrS noted during Jnspcerion Note Cstnectrans an atrufendum, t7 EFICI[�CE£9; FARTHER RECDOWATIONS. r Inspector's Inillals: Date: c�o AwnerfOperalal's InhlalsA- Date: 1. - 4 I W z PP•280(Rev 7I24t.)012)-Fage 8 u • t ' s �XOAZO'd aq 699 9L6(xvj) 1 !0 AQ I l eA 1OPtu l a-19H 23:C1- VII-M/ 190 PX Date/Time 06/26/2014 12.121 17812249908 P.022 f JVN-26-14 12:14PM FROM-Carnnonwsalth Tank 17012241200 T-008 p.022 F-997 IIIIIIIGMIMIIMUMM�Mw 111po No, Pipe No. pipe No. Pipe No. 1 Test maihod Is a 0.1 gph Ilghlness,tost. ❑Yes ❑No ❑Yes ❑lVo . ❑Yes ©No ❑you ©Nis 2 ANathod Name: 3 T19hinsss teat performed by(Person or Company Name): Lest lightness test tesults avallable and k passed.5hovrs no evidence of a pole Mal ❑Yes ©No ❑Yes ❑No' ❑Yas ❑No []Yzs Q No release. Tlghtnesa testing Is conducted%vllhln 5 speclfled Elmo frames for melhud;annually ❑Yes ❑No for presUdzsd piping;ovary 3 years for non. C1 Yes ©No Yes ©No Q Yes CQ No oxetn I suclion ppinp. it ffi ❑Pass ❑Fall ❑Pass ❑Fall' ❑Pass 0 Fall ❑Pass ❑Felt rf the answer to any question 15 No,pfeass oxglafn below,l.lsl any prnbloms noted during inspection.Note corrections on addendum. pl:sicte�c[Es; ' t't1R5H�R RerCohu�[}A1'10115� Pipe No.1 Pipe No.2 Pipe No.3 Alpo No.4 1 The piping slope Is back to the lank and ®Yes ©No ®Yes ©Na ®Yes C No ®Yes b No a eratos under atmospheric ressure or less. 2 Only one check valve is used. ®Y0 Q No ®Yes ❑No R Yes ©No ®Yes ©No 3 The check valve is directly under the ®Yes Q No ®Yes 0 No dIs ensinpump, Yes Q No ®Yes ©No ®Pass ❑Fall 0 Pass []Fall 0 Pass q Fall ®Pass [3>=a1I If lhu nnswar to any quastlon Is No,please ompiafn below.Ust anyprobloras naiad during fnspsctlon.Note corrections on arlotondum. OCFICfENCIES; (~uRfFil:,R Recr�rr�taonnoNs: I I Inspector's Inlllels: � Owner/Operstoes 1nillals•.,�%rft CJats, Date: /�W9 I i FP•280(Rev 7I34012)-Page 9 I! I 01 0'd mo nq us(xvj) 110 AaI Iell VLOU9Z190 RX Date/Time 0512612014 12:21 17812249908 P,023 Sidi-26-14 12,19PM FROM-Cc.remenwealth Tank 17912249909 T-008 P.623 F-907 71esf. cl e No, Pipe No, Pipe No. Pipe No. 1 Test method a 0.7 Aph EighineYes ©No Q Yes Q No p YesQ No ©YAs �j Np2 Method Name:3 Tightness test performedbt3M Compan Na e: t_ast tightness last results availiable and LT ed,Shows no evidence of a potential (]Yes ❑No q Yes ❑No ❑Yes ❑No ©Yes ❑No se. Lestesting Is conducted wit nme frames for method;annuallyQ Yes ©No ized piping;every 3 years far non• ©Yes ©No Q Yes ❑No QYes (]No etlan i In , F ❑Pass q Fal! Q Pass p Fall ©Pass q F811 ❑Pass ❑Fall !t Iho answerto sny qu0srlon!s Na,please expldln below.Leaf anyprobfams noted duNrtg/nspectfon.Nora eorraetlons on eddendum, BEFICENCIES; FURIH=p RECOMENDATI s: Pipe No.5 Pipe No,6 Pipe No. Pipe No. 7The stopo is back to the tank end Yes ❑Na Yes [k No Q Yas q No p Yesder atmos heria assure or lass. [J No heck valve Is used. ®Yes ©No 0 Yes ❑No ❑Yes Q No ❑Yes ❑No a value is directly under the Yes Q Na dis ono- um . 10 Yes ❑No [J Yes ❑No ❑Yes Q No ®Pass ❑Fall N Pass q Fail Q pass ❑Fail Q Pass Q Flail f�rhn nncwer fa any question!s Nu,planes explAln below.US(any prabloms noted during lnspeetlan.Nora oorrectrans on addendum. DEFICIENCIES: FURTHER RECOMMENnAIMNS; Inspectors Initials, OwnerlOperaloes Inillals:�1�(, pa1a: Date: V P289(Rev 7124P.012)-page 9 B ECOICN,d Im 693 m(w) 1 lb Ae1 1e11 oewi IaeW bS DI VLOU9Z190 -J RX Date/Time 06/2612014 12-21 17812249908 P.024 ,11111-26-14 12;15PM FRCt,!-Commanwealth Tank 1781224f19D8 T-008 P.024 F-927 rMiojr.Nanfoal k No. Tank No. Tank No. Tank No, 1 ectronic ❑machanfaal ❑Mechanical ]Mechanical ©Mechanical ❑Efeclranla q Electronic ❑Efecironic q Electronic 2 Make and Model Automatic Shut-Off Deufce(9.0)Restrictor Shut-UP Shut-off Shut-off Shut•p (R)Audible or Visllsle Alarm(A) ❑Aesirletor Residoor Resttictor ©RpefflgOt Alarm Afar Alarm ❑Alarm 4 ALLD device is performing end operallonat a ❑Yes ❑Ne ©Yes t 2:0 h 1t) a1 ©No. 0 Yes ❑No ❑Yes Q No ALLD devirr:is calibrated,operated,and 5 maintained par manufacturer's lnstrucfions ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No eXrarn b. u rfservito 6 ALLD has oparaled without evidence of a ©Yes _ release, ONO C]Yes ❑No ❑Ycs ❑No p Yes Q No 7 The entire piping System is covered by the (]Yes ❑l�to p Yes ❑No ALLD. C]Yes ❑No ❑Yes 0 No ALLD Is third•parly cerliriad and passed an n annual functional test each year prior to this ❑Yes ❑No ©Yes q No Q Yes ❑No ❑Yes ❑No ins action. All ALLI)s must pass an annual functional(opsraifon4 test,In accordance with menuracturer'a speciticallons,to assure it Is wonaltv Installed not tam ared orb assert,BIG. ©Pass ©Fait 10 Pass ❑Fell ❑Pass O fail Pass ❑Fall If rho answortn nay questlan is Na,plaaso expfeln WOW.r_isf anypro6tems natpd during inspection.Nafa corrections an addendpm, �eFl��NeIFs; FURTHEttRF_CtlNLU AT10N9: Inspector's initials: 1 Ownorloporator's Initials:ai► 6 Dow: / y9 � Data" IO.°'.I�'to r/• A L �I 1 FP•289(Rev 7124t2O 1 z)•11ugc 10 t:tl!IzZO'd i. epq us(Xv'j) 110 i €RA 10etu I J JQK t'S:C1. KOZ/9Z/90 RX Date/Time 06/26/2014 12:21 17812249908 P.025 JUR-26-14 It;fGPM FROM-Connanwaalth Tank 17BIZ240888 T-008 P.025 F-897 Tank No. 1 Tank No.2 Tank No.3 laddma... 1 £quipped with spilt bucket minimum 3 gal eapaclty. ®Yes ©No ®Yes Nn2 Bucket is ca able of returnin ❑ ®Yes rj Nop 9 prodmei to the leek. ®Yes Q Na ®Yes3 8mchel is clean end Tree of debris and wafer, ®Yes ❑No Ysea a9uchet and cover iswtihou#cracks ofholes observed. ®Yes �7 Nn ®yen ❑Naa ®Yes (]NoIII p pe 1.wllltout abnormalities observe (bent drop5 tubes,cracks or holes)especially at connectlan to ®Yes ®Yes ❑No 0 Yco I]No lank PAd 3 ill device, Q N0 FallKass p Fait ®Pass Q Fe11If the anstyar toany quosrlon is No,pfeaso"Plaft?WO v Llstarlyproblomseuringlnspecr1n14 Noll ea�racrlona on ... AEFiCiFaVcraa: • 4 FuRniER REer)St M)ATIoN5: Tank No,1 Tank No.2 Tank No.3 TanX No.4 1 Overfill device present(select primary): Automatlo Shut-off float valve(AS)Ball Float Valve(UFV) ®AS ❑BFV ®AS ]BtV ®AS C313FV AS Q SFV 1High Level Alarm(HIA) ❑HLA p HLA' ' • Q HLA 0 HLA 2 indicate delivery mslhad(gravity of metered flow) ®dravlty ®Gravity. ®Gravity 19 Gravity C1 Metered Q Metered. ' Q Metered Q Meterev 3 inspector veripes instaliaUDn doscribed below: 0 Yes p No ®Yes ❑No ®Yes [3 No IN Yes Q No Roqulrad.the instollaillon of A.)a dev ce vrhich shall automatically shut elf tiow into the tank when the lank la no more than 9507,fine or 04 a device that shall alert the Individual dalivoting the product when the tank is no more than 90%full by roalduling the flow Into the tank ortrl eri 8 hi h level a a Owner/opefatal ensures releases time to spilling of 4 overfiilin9 dd not occur, Far example,product!.c ®Yes ❑No ®Yes Q No ®yes ONO measured prior to each delivery to ensure enough mom ®Yes C]No In Tank far produg al1 fool dalivarlas aie manitofs Visually observed ovarfill device housing,documenialion S of install provided;OR cMIlGalton from service provider ®Yes ❑No ®Yen j]No ®Yee ONO ®Yes Q No aftestinn to auerfill device oparolalli!y provided, A$r VI&Wai abservotlon indicates the drop tube is 6 unobstructed(anything that would rendet the shut-off (@I Yes ❑No 0 Yes:M'No' IM Yes Q No eyes C No device ineffoaiive). 7 BFV:Valve andlor vent restrictor material is compet�bie With UST z to co uration product del€vet and use d Yes M NO ❑Yes ❑No ❑Yes ❑Na Q Yes [J No HLA. Alarm is tested find is funelloning property at stay,, -- 0 and is audible or visible to the driver of the point or ©Yes C)No ©Yes Q.No ( Yes ©No ©Yee ❑No transfer. Pass ©Fall ®Pass (]Fall Pass ©Fell 9 Pass Q Fall if thu answor ro any quasdlon Is No,plans&explain balOw,Llst anypfahfams crated during lnspeanon,Note corrections on addendum. l��fiC�ENCiEs; , FURTHER RrisommIENGATION$; ate: trrr's Inuialo; D e � Ownerlaperstoes Inillals Date: - � Aatat�A-�d f FP-289(Rev 71?411-012).Page I I mg 689 m(w) 110 Ael 12A b1_0;:19Zf90 PX Date/Time W 2G12014 12:21 17812249908 13,13213 .lull-26-14 12;16PV FROM-Commonwealth Tank 17012240900 T-000 F.020 F-997 Tank Na.5 Tank No.0 Tank No, Tank No. I /;quipped with apill bucket minimum 3 gal capacity, Yes [)No ©Yas ®No ❑yea ©No [ Yes ❑No 7 t3ucket is capable o}teturnfng pmduct to the tank. H You Q No ❑Yes ®No' ❑Yes ❑No Q Yea Q Na 3 Buccal Is clears and frees of debris and water. Q Yea ®No Q Yes ®No ❑Yes ©No Q Yee E]No 4 Bucket and cover is withoul cracks of holes observed. Q Yes ®No ❑Yes R Nu ❑Yes U No Q Yes ❑No FIII pips s without a normallt;es observed(bent drop 5 tubas,cracks or bolas)e2p601411y W connection to Q Yes M No M Yes ❑No Q Yes Q No ❑Yes Q No lank ands Ill device. • Q Pass F611 ❑Pass p Falf ❑Pass Q Fail Q Pass p Fall Irthe enswor ra any quesfian Is No,please explain below.List anypr�oblama noted duringlnspacllon.Nora corrections on addondrrrn. FURTHCRRecohiji pAmnNs, Tank No.5 Tank No,a Tank No. Tank No. 7H[gh ll davlco present{select prreall ntic Shut-off float valve(A Vslva(SFV) 0 SAS [3 BF'V ®AS Q BFV AS ❑8FV ❑AS Q(3IV evel Alarm(lrtA) ©HLA ' E HLA [(HU1te delivery melhod(gravity or meterao fleti� ®oravlty Gravity ❑Gravity p Gravity Q Metered ©M6lerdd [J Matared Q Metered inspector vad ies installation described below: 9 Yes ONO 10 Yes'©No ©Yas ©No ©Yea Q No fi'nqrrfrod:the Installallon of A.)8 devfca tyh c shall automatically shut off flow into he tan t when the tank is no more than 95°lo iu1!or U.)a device that shell alert the Individual dellvaling the praduci when the tank[a no more than 90%full by residcling the flow into site remit or Iringerinq a high level alarm. Ownorloperalor ensures releases due 10 spilling or 4 overfilling do not occur. For examols,Pfoduct is moasureelpfler to each dblivary to ensure enough room ®Yes Q No 0 Yea ❑No ❑Yes ❑No 0 Yes ©No in lank far mducY ell fuel derivarles are monfloted, Visually Observad overfill device housing;documentation 3 of lneta[I provided;OR carlincetlon from serviro provider ®Yas Q No ®Yes EYNo Q Yea ❑No Q Yea ❑No allosling to nyeftl device Operability aulded. AS; Visual observation Indicates the drop tube Is 8 unobstructed(anything that would rertderthe shut-off 0 Yoe ®No p Yes ®'No ©Yes ©No Q Yes No daules Ineffecliv8. 7 8 :Vatva and/or vaitt restrlclor material is compsllble wNh USTs slam configuration, roduct dolively,and use Q Yes Q No p Yes ❑No Q Yea ONO ❑Yes p No Ft LA: Alarm is tasted and Is funcilonlN property at 9D%. 8 and Is audible at visible to the driver at the paint of Q Yes ®No Q Yes [j No ❑You Q No ©Yes ❑No transfer. ®Paac 0 Pall ®Pass 0 Fall Q Aass ❑Fall ©Pass ©Fall ff the answor to any clonstion la No,picric axplaln below.List anyprabloms naiad during Inspsotlon.Note corrections on addendum. G9��ICIeNCIFS: ?uK HER R£CAr,1,,MijA'naNs; Inspectors tnlifalt;:c4e) �. OwnerlOporstor's tnhlals;}� r Date., PP-289(Rev F124/2012).(rage 11 1 ECO/ (I'd me 699 m(m) 110 4a1 IRA AORWIa.iaH99:131. PLOUGIZ/90 RX Date/Time 06/2612014 12:21 17812249908 P.027 JUM-20-14 12:I?PM FROM-Conmonvealth Tank 11812240908 T-008 P.027 F-087 31 . . Tank No. Tank No. rank No. Tank No. I Tank passed test in accordance w!th 527 CMR 9105 H ❑Yes ❑No ©Yes ©No ❑Yes (]No ❑Yes ©No 2 Pipe passed test In scrordance w11h 627 CMR 9.05 H Q Yes ❑No [)Yes ❑No 0 Yes ❑No 0 Yes Q No 3 Current record of cathadie protection teats on Me wnh o eretor ❑Yes ❑Nn Q Yes p No ❑Yes M No ❑Yes ©No 4towneror CP tests performed try: (Company Ntamp) S Is inspection parfaarrnert after repair of tank/piping? ©Yss ❑No Q Yee.❑No ❑Yes {�'No ❑Yea G If yes,was oalhod!c project on system ©N° testedlinepected within BO days 0f repair of UST ❑Yes Q No ❑Yes ❑No ❑Yes ONO ©Yes ❑No a stem In accordance wit 527 CMR 9,05 N f3 MEW" MEW [I Pass p Fall ©Pass ©Fall 1 ©Pass ❑Fall C3 Pass 0 Fall rrrhn answer to any gaesflon is Na,plaits@ explain below.llbl any preblMaa noted datrfag In-IPWIDM.Note correatlonai err addand-um, esrmctENctm: FuR HEfitRffWMMPN0Ar1rSW: 1 i Hill . a Tank No.1 Tank No.2 Tank No,9 Tank No,4 1 System has power and Is turreted on: ®Yes Q No ®Yes O-Na ' ®Yes ❑No Yes ❑No 2 80•day log is present and filled out properly,in eccordance,uflh 527 CMFi 5.05 H N Yes ❑No ®Yes ❑No ®Yes Q No ®Yes ©Ng I S Tank passed fast In accordance w11h 627 CMFi ®Yes ©No Yes ❑No ®Yes ©No ®Yea ❑No Plpe passed lest to accortlancn wlltt 627 CMR 14 0.06 H (R Yes [')No ®Yes [I-ND ®Yes Q No ®Yes (:]No 5 Inspector veflRes tttiat inspection results are an file ®Yea (�No �Yes _- with local tire department, Q No ®Yes ❑No ®Yes . . C71Vo 13 C13 tests parfarmed by: NortherriTcOnleal NorlhernTechnleal Nort4emTeetynieal Rarthern echnlcam sarvlces 5ervteas sarvIces services 7 Is Inspection anal repair of tanklplping? ❑Yes �Na ❑Yes 0 No ❑Yes Cl No ©Yes ❑No If yes,was cathodic protection system ll 1tasmdnnspeated within 60 days of repair of UST ❑Yes Q No 13 Yes []'NO.' Q Yes Q No ❑Yes ❑No system In accurdance vAth 527 CMR 0.QS H B e Pass ❑Fall ®Pass 0_Fall• ®Pa3ss ❑l=aH ®Pass Fall rr fho answer ro any quostraaM!S N@,ptatasa3 explain barot5i.Llsf any problems Hated durtAg 1riSpeatfon..Nofe Corroctlnns an addendum. UEFICIENCtm FUarmm en RsCOfdMDATIONS: InspeeloYs Initials: � G_fy Owner/Operators In'€€ttals): A* FP-289(Rev 7/274/2012)-Pnga 12 GIL?Q'd I !0 da[309 699 9160j) l lad ew! r aaW55 t bt-0uez/90 RX Date/Time 06126/2014 12:21 17812249908 P.028 J1.1I1-26-H 12:1M1 FROM-Connenwealth Tank 17012240908 T-000 P.020 HOT 1 1 Y ! Lank Na, Tank No. Tank No. Tank No. 1 Tank passed test In accordance v+ith M CMR 9,05 t{ p Yes ❑No ❑Yes .p No L7 Yes Q No i]Yes ❑No 2 Plpe passed test in accordance MR 327 CMR _ Ye ❑Na Q Ys.❑Nog.p5 H ❑Yes ❑No ©Yes ❑No 3 Current record of cathodic protection tests on fife with owner nr© orator. ❑Yes 0 No ❑You ❑No ❑Yes o No ❑Yes ❑No R OP lasts performed by: (Compsny Name) 5 Is Inspectlon performed after repair of tenklpiping9 ❑Yes ©No ❑Yes a No t❑Yet: 0 No ©Yes ❑No 6 af cathodic protection system ected within 60 days of repalr of UST ❑Yes ❑No Q Yes 0 No ©Yes ❑No ❑Yes d No accords ee with 527 CMR 9,05(H 6 if ❑Peas ❑Fall [7 Pass ©Fail ❑Pass Q Poll ❑Pass q Fall lrrho answer to any quesilorr is No,phase explarn below.Ustonyprohloms noted during inspection,Note cormetlons on addendum. pa11C1ervcrss: . F1lffll-{FR RVOOMMI)A510N9: Tank No,6 Tank No.B' Tank No, Ten%No, 1 System has power and Is turned on. , ®Yes Q No ®Yes ❑No" ❑Yes Q No ❑Yee ❑No 130-day og is present and filled out properly In accordance YAM 827 CMR 9.05 N ®Yes 0 No 0 Yes ❑No_ . C1 Yas M No ❑Yes Q No Tank passed lest In WOrdonce with 527 CMR 0 9.05 Ft Q Yes ❑No 1]Yes �)No,- ©Yes ❑No ❑Yes ❑No 4 Pipe passed te9t In accordance with 527 CMR ®MUM Yes ❑No ®Yes [INo [I Yea ❑No ❑Yes ElNo 5 Inspecrorvo6fias 1hatin3pection results are on rile M Yes ❑No 4 Yes Q No ©Yes ❑No ❑Yes ❑No with local fire department. fi C P tests performed by; NonhernTeettn cal NorthamTechn lcal _ Services Seruleas 7 is inspection after repair of tanklpfping? ❑Yell ®No Q Yes ®No. ❑Yes ❑No ❑Yes ❑No tryes,was calhodlcprotaction system A tastedAnspecled within 60 days of repair.of UST ©Yes ❑No ❑Yes ©No ©Yes ©No ©Yes ❑No s slam In accordance with 527 CMR 9.06 H fi (�Pass ❑Fall ®Pass ❑Fall ❑Pass ©Fail Q Pass ©Fell it the Primer fo any que,eflan 1F H%please explaln below.Ust anyproblarns noted during Inspectlon.Ante aarreerlons an nddandum, DEFICIPMES: I=Uw;MF.RFZ£CQ wNOA710Ns: tnspactaps Initials: + OwnedUperalorls InlVals; �y�� Date: pate: FPY289(Rev 712412 0 1 2).page 12 ,'CO/KO'd aq 699 916(m) 110 Aa I IRA Aoew IA-12W 1S:C1_ VI-W/K190 RX Date/Time OV26/2014 12:21 171312249908 p,029 JUN-26-14 12:t7Pli FRfll1-Cnnaionwealth Tank 17012249906 T-006 P.020 f-217 Tank No, - Tank N6.; Tank'No. Tank No. 7WTank-, er wall made of non•malalllo material such as fbar lass or fiberglass clad steel, ❑Yes ❑No (]Yes' ❑No ❑Yes El Na p Yea (�No 2 Pipo:Dul6twali made of non-metallic material such ns fiberglass or corrugated lasilc. C.3 Yes ❑No ❑Yes-U No ❑Yes 0 No ❑Yes ©No Nane of the fallowing conditfarin woad observed In Ileuibie piping: swelling,elongation;kinking, 3 wrinkling,blistering,delaminating,softness,mold p Yes []No ❑Yes ❑Na ❑Yas ❑No ©YAP, ❑No grotivth,or other abnormalities? Describe In #oficiencies below, ❑Pass ❑Fail Pass []Fall ❑Pass {a�Ralll ❑pass Q FAII N the answer to any quastlan is No,please explarq below,Ltatany problems noted during lnspectlorr.Note corrections an adNandum. l��ic��yaEa:s: 1'U"(EA RECOMMIMATM: Factt•t1Y: 1 How is water stipplled to your faclfity7 Cl Private Well Municipal Water supply If pdvale wall,answer. , pc you ssrve walar to al feast ifs different people at feast 60 days of the 12 year?Examples lasluda:provlding water fo dtink rmm feurofs or bubblers,• �Yes ©No having resrroom vfng s,sar orselling coffee or olherbevaragas made tvflh,ar rnlxed with wal4ir _ If You,answer 3,4,5 6,6 3 Do you have a Public Water iry-Btem Identification number{PWS IA#)tram _ MaRGD5 ? ©Yes,Q No 4 If Yes,provldo 1011: s Verify that location of this well—Is show on the sketch In Section 2.C.marked _ as DW. ❑Yes.Q No 6 Verify Fmwooncy Call List poeted with Information that there Is private w811 on site. 0 Yes.I]No 7 Vorlfy that A,9 d,C operators have been trained 0 Yes ONO U Pass•❑Fall 0 Not Apply IF the enswOr to any question Is No,please explain below.List any probloms noted during l►rspaction.Nat©corrections on addana'urn, QEF3frpjlCiGS: FuR,arER RE:aoMVeNOA noN& inspector's Initials:G .,4 Owner/Operalues Inilials: ear FP-289(Rev 712412 0 1 7)-Page 13 i :' r3llj'0'd l•S178 699 8L6(XVA) I l0 Ael lei Inowia 1eW95 £l bl•0619Zf90 J RX Date/Time 06126f2014 12:21 17812249908 P.030 1UII-26-14 12:18P11 FROM-Commonwealth Tank 17812r49909 T-006 P.030 F-997 Uld • • �• ` PACILtiY; During this inspectian,have you idonillled any releases,leaks,Or guspeoted 1 leaks that must be reported to Ma93DEP per the Massachusetts p yes M No Conlin enqV Plant(31 0 CMR 40.0900 7 If YES answer 2 3 &4 Date Rapaded: 3 Time Reported. (Use 24 hour clock) 4 Release Tracking NumberSRTN); 5 Hes the system been taken off-line due to[his leak or suspected leak? Q Yes (]No 0 Was a repair made due to a leak that was repaited to MassDEP? Q Yes ❑No Q TanK 7 Source of Release: Q Piping Q Dispenser Subinorslble Turbine Pump ❑Delivery Other. ❑Spill Q Overfill a Cause of Rulease: Q PhMcallMachanlcal Damage Q Corrosion ©installation Problem Other: IIR Pecs Q Fail REPowr ALL SPILLS, LEAKS, OR SUSPECTED LEAKS TO P LOCAL FIRE DEPARTMENT ' AND MASSDEP CALL 888-304-1133 Ir Ills answer to any questlan is No,please explaln below.Mar anyproblems naiad during Inspection,Note cor octrons an addar,dvm, Dss�ciet�c:ss; QUAn+srzRccorr, ENVAt ONS, Usa this section to list additional comments not listed In the previnus pages. Attach another page if necessary. 4wnamloperators are required to roport unusual operating conditions to MaaSDEP,'Were any unusual operating conditions 1lasarved7 _ Tanks S,2,4 and 5 mesurered front 112 to 2"of walor._Need to remove: No A,B,C operator assigned to the facility. inspector's lnittals; � Owner/t7peratare initials; ii FP-289(Rev 724/2012)-Page 14 I -'CW0CG'd 1.309 699 szs(XVA) 116 491 IPA 10ew1aaaWG3::I• VLOZ/9Z/50 RX ©ateM me 06/26/2014 12;21 17812249908 P,031 k1i-216-14 12:18PM FRORI-CealaanwealIli Tank 1iBi2249908 T-008 P.031 F-921 Certification Is a license to store flammahles/combustlbios pasted on site(Forth FP-2)? 19 Pass ❑Fail ❑NIA Is a current certificate or registration posted on site(Farm FP-5)? ®Pass Q Fall ❑NIA to a currant permit to maintain UM posted an alto(Farm FP-290 part 3)? '®Pass ❑Fall ❑NIA Is the current Form FP-290 accurate?See. i.A 8 2,A..rnuslmaich the PP-290 ®Yes ❑Ne Verl1y that A,S.&C Operators have been trained. ❑Pass 12 Fall ❑N1A Attach most recant Form FP-200 ®Attached inspection Results Sectlon&A:Aulomallc Tank Gauaing ❑Pass l@ Fall ❑NIA Sectlon 3.11.Continuous in-Tank Leek Delecllon System(CLOS) ❑Pass ©Fall iM NIA Sectlon 3.C.interstlllal Monitoring ❑Pass ❑Fall 1R NIA Section 3.0:Stailsiicat Inventory ReeonelltaUnn(SIR) p P4ss 0fall 19 N/A Section 3.P-:Pedodlc Tightness Towing 0 Pt395 ©Fell 0 NIA Section 1F:European Suclion ❑Pass ❑Fail ®N/A Section 3.Gt Annual Automatic Line Leak Detectors ❑Pass 0 Fail ®NIA Section 4.A:Spill Prevention ®Pass ❑Fall ❑NIA Section 4.8:Ovarfiil Prevenllan ®Pass ❑Fail ❑NIA Sootion S.A:Corrosion Prevention—Galvanic Cathodic ❑Pass ❑Fall ®NIA Sectlon 5.8:Corrosion Prevention—IMPrassad Current Cathodic Pass d Fall ❑N/A Section S,C:Corrosion Prevention—Non-Motel ConsUualtan Material ©Pass ©Fail N/A . Section 8:Water Supply information ( ❑Pass ❑1"ail ®N/A Section 7:Reporiing of Release,Splil,Suspected Leaks Pass ❑Fail ❑NIA 1,Ihs Certified Inspector,have performed this UST Inspection and 1,the Owner/Opefalor(q[rt la ono),have read this Inspection believe the contents of this repoO to ba true and accurate at the Report and have b6an'told the condition of my UST facility, time of inspection.i also have no significant financial interest with Including all deFciancies,corrections and recammendettons.All this UST. anoficable Vanaeam InhintedAQUaluded fa„(&submrrfaf. Facility 010705 Print Nams: Print Name:Lule A.Diaz Signature. 1 Signature: Emall: Email:Idiax ommtank,com Phone: r •3 i Phone:617.628-8260 Date: inspector 10:1083 Date: Mail Completed Forms Department of Environmental Protection No Liator Than Bureau of Wesin Prevention—LIST Program 14 days . P',O.l3ox 120.0185 Ffam the Dole 8o4tan,MA 02112-0165 or the Inspection to: and sand copy to local lira department inspector's Initials; OwnedQperator's Initiet FP-289(Ilev 7124/2012)-Page Is i:0OMOO'd 1.309 699 9L&(Xvj) 1 1 O Ae f IRA aetu i raay{pG: t KOWU90 J RX Date/Time 06/26/2014 12:21 17812249908 P.032 JUN-26-14 12:19PR PROYrUnraam+eaIth Tank 179122489OB T-008 P.022 F-99T L1ate: •• racility game, t]EP Fill Lumbar; Re uirod Use Ihls Mlion fo note any deficiency corrections or repairs thatwers rnsde after the Initial lnspoctlon. The USTthird-party Inspection should be a'snapshot'completed prior to any repairs or adjustments that would affect whether or note UST would pass or fall. List each corrected item separately. If you have any questions,please call the Mass DEP UST office at 617-556-1035.Use additional copies of this page if necessary. Ham 1. flute of Work: Tank or Pipe# is now: [ Pass QFaiI the Inspection(check one) 1)eseription of Repair of Doflclency Correction: UST Worker Name: tJS"f Worker signature: Data: Itanl 2. Crate:of Work; Tank or Plpe# Is now; C7 Pass OFoll the Inspectiop(check one) Description of Repair of Deficiency Correction: UST Worker Name: UST Worker9ignatura: Date., item 3. Data of worh: Tanis or Pipe# Is now: ❑Pass ❑Fall the Inspection(check one) Doscription of Repair of Deficiency Correction; LIST Worker Name: UST Worker 810nntuta: Dale: Item 4. Date of Work: Tank or Pipe# is now: 0 Pass OFeit the Inspection(check and) Descriptlon of Repair of Deficiency Correctlon: UST Worker Nama: US7 Worker Signature: Cate; Mall Completed Forms Department of Environmental Protection No Later Thaa Bureau of Waste Prevontlon--UST program 14 Days P.O.Box 120.OIGS From the Pate Boston,MA 02112.0185 of the Inspeclloh to; and send'copy to local fire de artmant Inspeetof u Initials: Afi Ownerloperators Initials; FP-289(Rev 7124f30I2)-Page 15 QIZt O'd L309 699 8LG(Xvj) I 10 AQI lerl )l0eWIJJGK00;K MMU90 E l ii RX Date/Time 08/26/2014 12:21 17812249908 P.f)33 JUIi-26-14 12:1915M F110*CaruronRoal th Tank 1781224AA0A T-t10A P.033 F-997 1 aen:ty_Netne DEP Faclilt'y 10 Number; Ragrllfed Use this section to note any dofiaienay Corrections of repairs Iha1 were made after the Iri HO Igspaation. The UST third-party lnspao ptt should be a'srspshol'completed prior to any repofrs or ad)usimenis that ulauid af(00t whalharor Rol a UST would pass or fall. fist each corrected ilern separately. if you have eny questions,pleas Call She MassDEP UST office a1647.556.1039,Use additional copies of this page if necessary. Item 1, gala of Work: Tank or Pipe fl Is now; ❑Pass ❑Pall the Inspaotidn(check one) Descrlplfnn of Repair of r oflcfenoy Correction: UST Worker Narne: UST Worker Signature: Cate, Item 2, Dille of Work; Tank or Pipe t1 Is now: c �Pass ❑Fail the Inspection(check one) Puscriplion of Repair of Deficiency Correction: laST Worker Marne; UST Worker Signature; :3 Dale; item 3. late of Work: Tank or Pipe 4 Is now; pass ©Fail the Inspection•(check one) De:}criplion of Repair of Deficiency Correellon: OST Worker NoMo: i15T Worker Signature: Cate, Bern h. !late of Work Tank or Pipe# Is now; ❑Pass ©Fail the Inspecllon(check one) Descrfptldn of Repair of❑aticlency Correction; t1ST Worker Nome: UST Worker Signature, ❑ale: Mail Completed Forms Deparimenl of Snviron=depu,,,,,tn Na later Than Bureau of Waste Preventm �A Days P.O.Bax From the t?steBpslon,MA 02Lof the Inspecllorr to: and send copy 101ooa Irlsp®oar`s Initials:t 4Wn000perator's initials: FP-299(Rey 7/24/2012)-Page 16 XOICCO'd l.W9 609 9l6(XVA 110 A911erl �oewlaaaW00:�L t21.0Z/9Z/90