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. Designated Underground Storage Tame(UST)Oerator Monthly Visual Inspection Checklist Facilit Name: 99 Shell Date: �acili Address:7700 Moreland Ct City: Stockton Zip Code. Designated UST Operator Conducting the on: Lori Freshour International Code Council Certification#: 5220353-UC Ex imtion Date: 9/17/07 Signature: Phone: (916)826-1576 Item MONITORING PANIU-1 ALARM HIS11ORY Y N NA 1 Monitoring system is powered on and in operating mode 2 monitoring s cm is not cuffaidy showing any alarms or warnings _- 3 Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST Operator. (Attach a copy o the alarm history report/log to thisform i available) 4 1•;ae-h alarm for the previous month has been res nded to appropriately- 5 Sensors located in the tank-top containment sumps have not alarmed in the past month 5a Lis(all tank-top sumps where alarms occurred in the past month: Note:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to.and N�1 properly addressed,the cause of the alarm. Attach documentation verifying appropriate service to this report. Ifsump ins ion is required,record results in item 6,below. UST SYSTEM INSPECTION 6 Tank-top containment surnps are free of water,debris,and hazardDw substance. Sensors are properly located We Visual wkspection of sumps is pq rogirad in sum where an alarm has occwod in the t month kr which there is no service reco•d Y N Y N Sump Location. Sump Location.- Sump ocation.Sum Location: SumD Location.- Sump ocation:Sum Locabion: SyMp Lordtion: 7 Spill containment structures are tree of water,debris,and haAffdous substance. . Y N NA Y N NA Tank 1-Contents t!.i' y Tank 3-Contents Tank 2-Contents pO 12 Z Tank 4-Contents 3 UDC areas are tree of water,debris,and hazardous substance. Sensors areV2p9dy located Y N NA Y N NA Dispenser 1/2 Di nser 9/10 Dispenser 3/4 Dispenser11112 i Dispenser 5/6 Dispenser 12/13 /�l Dispenser 7/8 Dispenser 14/15 !ti/ PAPERWORK INSPECTION Y N 4HADATE DONE 9 Monitori em certification has bow eted within the t 12 monthls. -`�-C10 Contaimient tests have teen eted withinthe red timeframe. / 11 11 contai structure et testi was completed within the ` 'C 12 Tank titesti was eted within required timeframe. 13 Line tightness testi was deed with red timefrarne. /�/ rj; 7ZIMaintenance: ed testi maiptedWlce was completed within red timdrame. bst test/maintenance items below Maintenance: Maintenance. FACIUTY EMPLOYEE TRAINING Y N NA 15 All facif have received the reWired on- ob trainir within the t - 16 1 All facility ' hired within the past 30 day have received the red on- ob training Note:Any answer of"N"shtwld be explained in IJV comment section on the following page,and will require follow-up action. t%mments: rollow-up action required: ' • .1 m- =G ,. - ti •. 'T — 11 "[LTD !� CA 4., . " .t. •i . ��l � b � a Dealer/Manager Signature: Date: