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MARIGOLD SHELL 6131 PACIFIC AVENUE, STOCKTON, CA UNDERGROUND STORAGE TANK SYSTEM. v.SIGNATED UST OPERATOR MONTHLY INSPECTION REPORT :i\ Name: Marigold Shell Inspection Date: ,t` Address: 6131 Pacific Avenue City: Stockton, alifofni 95207 of Desi-hated UST Operator Conducting Inspection: Kathy Kotulak rational Cod C uncil Certification No.: 5240722-UC Expiration Date: 7/29/2016 1 cure:____ Phone: /A.�u � (925) 413-7422 ext. , N/A=No(Applicable MONITORING PANEL/ ALARM HISTORY Yes No N/A Is the monitoring system powered on and in proper operating mode? ❑ ❑ Is the monitoring system not currently showing any leak alarms? ❑ ❑ �: Is the Alarm History Report/log for the previous month available, and has it been reviewed by the Ito ❑ ❑ Designated UST Operator? (Attach a cop), of the alarm history report/log report/logto this inspectionform.) Has each alarm for therevious month been responded to appropriately? EJEl UST SYSTEM INSPECTION Are tank-top containment sumps free of water, debris, and hazardous substance? Note:If the answer to Item 4 was -Yes,"skip to Item 6. Sumps where an alarm has occurred in the past month must be inspected if a qualified service technician has not responded to, and properly addressed, the cause of the alarm. Documentation veri ing appi2eriate service should be attached to this report. Yes Noaat� Yes No k: Sump Location: Sum ❑ El Location: Z Sum Location: ❑ ❑ Sum Location: ❑ ❑ Ares ill buckets (containment structures) free of water, debris, and hazardous substance? Yes No N/A I Yes No N/A FTank 1 ID— Regular 87 ❑ ❑ Tank 4 ID— ❑ ❑ Tank 2 ID — Premium 91 1141 ❑ ❑ Tank 5 ID — ❑ ❑ Tank 3 ID —Diesel ##2 F-71 ❑ Tank 6 ID— ❑ ❑ Are under-dispenser containment areas free of water, debris, and hazardous substance'? Yes No N/A Yes No N/A Dispenser— 1/2 ❑ ❑ Dispenser— ❑ ❑ 1 0 Incorrect expiration date for Kathy Kotulak's International Code Council CA UST system operator certification Photo taken on:8/19/2016