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SHELL O&MPANY&ERTIFICATION OF TANK Ivel fGii 'v <br /> Facility WIC Number: 264g720=0•S—OL <br /> Facility Address: /(97/ ,4/( M141 q <br /> �}1Pm+ceA- C or g S3 3� <br /> Purpose of Visit: 7'j Te S �ll <br /> Tank Material: ( 4.8teel [ ] Fiberglass <br /> Line Material: [ tJ.Bttf ( J Fiberglass <br /> Product Tanks: ( in Wall [ ) Double Wall <br /> Product Lines: [ ngle Wall ( ] Double Wall <br /> Waste Oil Tank: [ ] Single Wall rG [moble Wali Lcg <br /> PRODUCT TANK MONITORING SYSTEM: <br /> QTY TYPE <br /> [ ) Interstitial Monitor ( ) Wet [ ] Dry <br /> ( j Vadose Zone Monitor <br /> I ,1 Fill/Vapor Recovery Risers <br /> [e.Y Monitored Visually (Daily Inventory) <br /> Manufacturer: [ j API Reservoir [ ] API IR (VADOSE) <br /> ( ] API MOS(VADOSE) ( ] Genelco ( ] Leakalert <br /> ( ] OC reservoir ( j Pollualert ( ] Red Jacket <br /> ( ] Soil Sentry ( ] Spearhead [ ) Other <br /> Model: <br /> Arriving Status: ( ] Operational [ ] Non-operational <br /> Corrective Action: [ ] Performed [ ] Required <br /> Departing Status: [ ] Operational <br /> [ ] Non-operational <br /> REMARKS: <br /> PRODUCT UNE MONITORING SYSTEM: <br /> QTY TYPE <br /> [ J Electronic Line Pressure Monitor w/ Mech. Leak Detector <br /> [ 1 Electronic Line Pressure Monitor w/o Mech. Leak Detector <br /> [ ] Interstitial Monitor w/ Mech. Leak Detector <br /> Mechanical Leak Detector Alone <br /> Electronic Line Pr uure or Interstitial Monitor Manufacturer: <br /> ( J API Pressure ( j API Sump ( J API Sump/Line <br /> [ ] Leakalert ( J Other <br /> Model: <br /> Arriving Status: (Operational [ ] Non-operational <br /> Corrective Action: ( ] erformed ( ] Required <br /> Departing Status: Operational [ ] Non-operational <br /> Continued on Reverse <br />