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(Q (Dt: <br /> (D —' 0- <br /> N <br /> 0 0 M Oesignated I Inderground Storage Tank(UST)Operator <br /> -+ '�� (\It,nthl� Visual It'sPcction Checklist <br /> W Facility Name:Shell Date:0129/14 <br /> Facility Address:7700 hloreLuld Ct <br /> N Q <br /> N O Citi:Shxkton Zip Code:95212 <br /> p-0 Mk i,nale(t 1 iS} lUrator Conducting the Ins ction:Karen R Arnaiz <br /> ur International l;ixir council ferlification#:8032295-UC F.x iration Date: OS?31/15 <br /> Sicnwure: ' Phonc:(209) 518-4836 — <br /> �l Not A !cable <br /> Cp Q ltcri! MOXqORING PANEL/ALARM HISTORY Y N NA l V <br /> I Monitoring system is powered on and in proper operating mode. X <br /> 00 _ Monitoring system is not currently showing an•alarms or warnings. X <br /> 73 <br /> Alarm history report,'log for the previous month is available,and has been reviewed bF the X <br /> Q Designated UST Operator. (Atrach a co •of the alarm histoty repurillog to tris Dery if mailable.) <br /> O <br /> C) 4 Each alarm for the previous month has been responded to appropriately. X <br /> (D <br /> 5 1 Sensors located in lank-top containment sumps have not alarmed in the past month. x O <br /> QJ <br /> (D >a List all tank-trip sumps where alarms occurred in the part month (D <br /> O ,fore Sumps whereon alarm hat occurred in the past month must he inspected unless a yuallfred servtcc'teehnrrran responded to.and <br /> 0 proverlP addressed the muse of the alarm.Attach documrnrauon rrrthvnx appropriate service to thus report <br /> 17 ser iS actin is required,record results in nem 6.Mini. O <br /> D UST SYSTEM INSPECTION --� <br /> 6 Tank-top containment sumps are free of water,debris.and hazardous substance. Sensors are located properf,. <br /> ,Ra(E:r aTtll 1 coon of su tis rink n• erred m s where an alarm has occurred in the w.0 month for n hick there n no sen•icr mon! _ <br /> N Y N I IYfN <br /> co <br /> Sump Location:87 Fill I X Sump Lvcatirnr. 87 Turbine X <br /> Sump Location:91 Fill X Sump Localion•91 Turbine X <br /> Sum Location:Diesel Fill X Senn Location. Diesel Turbine X <br /> F- <br /> (D 7 Spill containment structures are fire of water.debris.and hazardous substance. <br /> Y N NA I I Y I N NA I ^ <br /> Tank 1-Contents:81 1 X I Tank 3-Contents.Diesel X IlJ J <br /> Tank 2-Contents:91 X r—F <br /> (D8 Under-dispenser containment areas are free of water,debris.and hazardous substance. Sensors are located rorh. <br /> Q. <br /> O Y N NA I Y N I NA r/1 <br /> _0 Dispenser 1/2 X rh <br /> (D Dis enser 3/4 X O <br /> Dispenser S/6 X �1 <br /> 0 Dis eraser 7/S X ` J <br /> -, Y N NA DATE DONE _� <br /> (p PAPERWOR-d 'O <br /> CTION 0814113 O <br /> _0 9 Monitoringsystem certification has been completedn ast 12 months. X <br /> O 10 Second containment tests have been completedthe required timeframe. X <br /> -, 1 1 Spill containment structure(bucket)testing wawithin the ast Year. XD12 Tank ti= tness testin g was com leted within reframe.13 Line ti mess testinr was com leted within rcframe. A <br /> n 14 Other reguired test ing/maintenance was completed within re uired timeframe. (List tett ntainrenann items bels».) e , <br /> � TerdAfuirae+rance: I <br /> TestlAlaintenance. <br /> T__.ear <br /> Cit) CD <br /> v <br /> O x 3 * s .i CD a) io <br /> •'e' _ .p W Ll •J N Ifi �1 <br /> _ - Iv <br /> O 0 <br /> 0 <br /> 00 to - <br /> (D <br /> CTl Ott 741 u <br /> c:.<v <br />