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UNDERGROUND STORAGE TANK SYSTEM Jilll 1,300161 ii Facility Name: Shell 1-5 MONITORING PANEL / ALARM HISTORY Inspection Date: VIC-Anuary 18, 2012 Facility Address: 717 W. 8h- St.City: Is the monitoring system powered on and in roper operating mode? Stockton Name of Designated UST Operator Conducting Inspection: Robert Barnhart InternationalCouncil Certification No.: P52540 -u -C 1 -0 3. Expiration Date: 1/28/2014 1 Signature, --j Phone: (209) 604-9336 ext. 01 N/A = Nnt A ..16. hi. Item MONITORING PANEL / ALARM HISTORY Yes No N/A 1. Is the monitoring system powered on and in roper operating mode? 2. Is the monitoring system not currently showing any leak alarms? 3. Is the Alarm History Report/log for the previous month available, and has it been reviewed by the Designated UST Operator? (Attach a copy ofthe alarm history reportllog to this ins pectionform) alarm4. Has each for the previous month been responded to appropriately? ID 13 W - UST SYSTEM INSPECTION 5. 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 vera to appropriate service should he attached to this re ort. Yes I No Su Sum Location: Yes Nom Li s Sum R Location:: Sump Location: 101 Sump Location: 6. Are Till buckets (containment -e of water, debris, and hazardous substance? Yes No N/A Yes No NIA Tank I ID — Regular ❑ Tank 4 ID — El 0 El Tank 2 ID — Supreme Tank 5 ID — Tank 3 ID — Diesel I Z 10 1 [:1 Tank 6 ID — 7. Are under -dispenser containment areas free of water, debris, and hazardous substance? Yes No N/A. Yes No N/A Dispenser — 1/2 ❑ Dispenser — 9/10 Dispenser — 3/4 LJ Dispense — 11/12 El 0 Dispenser — 5/6 Lj Dispense — 13/14 49 FM 0 El Dispenser — 7/8 ❑Lj I Dispenser — 15/16 8. Leak detection is properly located within under -dispenser containment. Yes I No N/A Yes No N/A Dispenser — 1/2 1 El Dispense —9/10 El 1:1 Dispenser — 3/4 El -Lj Dispense —11/12 Dispenser — 5/6 Dispense — 13/14 Dispenser — 7/8 1 El ET Dispenser , —15/16 0 1 ED -1 7 PAPERWORK INSPECTION Yes No Date Done 9. Monitoring System Certification was completed within. the past 12 months? M 4/19/2011 10. Line Leak Detectors were tested/certified within the past 12 months? 4/19/2011 11. Spill bucket (containment structure) testing completed within the past 12 months? 1 E:1 Lj 4/19/2011 _12. Line tightness testing completed within the required time frame? 13. 1 Secondary containment tests completed within the required time frame? 4/21/2009 -14. Enhanced Leak Detection completed within the reguired time frame? Li I Li N 1 15. Other required testing/maintenance was completed within required time frame? (List test/maintenance items below.) - Describe Test/Maintenance: Air Quality I Z El E 2/3/2011 Describe Test/Maintenance: I I FACILITY EMPLOYEE TRAINING Yesl No 1 16. Have all facility empl—ees received the required on-t-hejob training within the 2ast year? 17. Have I fhciliemployees hired within ast 30 q!XIreceived ,the .required on:the-'ob training.? F-1 I I I 15ZI Note: Expiain any --NO- answers in the"Comments" section on the following page. Those issues require corrective �action from the UST owner/operator. UN -057 - 1/2 www.unidoes.org 9/26105