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Designated Underground Storage Tank (UST) 6perator • Monthly Visual Inspection Checklist Facility Namc: 99 Shell - Date: '9/3614) L• G 2 �: 4• kility Address:7700-Moreland Ct City: Stockton Zip Code: Designated UST Operator Conducting the Inspection: Lori Freshour International Code Council Certification#: 5220353=UC Expiration Date: 9/17/07 Si •ture: Phone: (916)826-1576 IL m M0NI'1)0MNG PANT L ALARM H191)0R Y N NA 1 Xf.mt ving system is powered on and in proper operating mode 2 Monitoring system is not currently showing alarms or warnings 3 Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST( x3ator. (Attach a copy of the alarm history report/log to this form if available) 4 Each alarm for the previous month has been responded to appropriately. 5 Sensors located in the tank-top containment sumps have not alarmed in the past month 5a list all tank-top sumps where alarms occurred to the past month: _— Note:Sumps where an alarm has occurred in the past month must be inspected unless a quabfied service technician responded to,and properly addressed,the cause of the alarm_ Attach documentation venfymg appropriate service to this report. Ifsunip inspection is required,record results in item b,below. i4-- UST SYSTEM INSPECTION 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are Properly located Note:Visual of sumps is onlyr red in sumps where an alarm has ooaired in the t month kar which there is no service record Y N Y N Sump Location. Sump, Sump Location Sump Location: Sump Location: Sump Location: 7Spill containment structures are free of water,debris,and hazardous substance. Y N NA Y N NA Tank 1-Contents t_ Contents n i L y _ Tank 2-Contents (ZG Tank 4-Contents Pi 4 8 UDC areas are free of water,debris,and hazardous substance. Sensors properly located Y N NA Y N NA Dispenser 1/2 Dispenser 9110 Di riser 3/4 Dispenser 11/12 Di user 5/6 Di nser 12/13 ti!� Dispenser 7/8 Dispenser 14/15 PAPERWORK INSPECTION YN NA DATE DONE 9 Monitoting s tem cf6fication has been completed within tete past 12 months. --0-t7S 10 Seconds Contaimnent tests have been ' completed within the red timme efra . N r t 11 Spill containment structure Picket tesfiN was completed within the past yW. `- 12 Tank tightness testing was cornpleted within required timeframe. A 13 Line botness testing was completed with required timeframe. 14 Other required testing maintenance was completed within required (list test/maintenance items below Test/Maintenance: LjLp Test/Maintenance: Test/Maintenance: FACILITY EMPLOYEE TRAIMW Y N NA 15 All facifaTooyees have received the required on-five-job bArung within ft past year. 16 Al facilitV employees hired within the past 30 day have received the reqwred on-tejoP train . ' KA Note:Any answer of"N"should be explained in the comment section on the following page,and will require follow-pp,action. Com ents: itt -- IZt�t l`:�nYY1 11C C S`; T(; G - (' (ltbCK�='d� bar '� l•i`X� � Gt2 ��L� • Follow-up action required: ..healer 1 Manager Signature: Date: