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SHELL OIL COMPANY - ITIFICATION OF FILL TUBES & INSPECTION OF SPILL BOXES <br />Station WIC Number: Zp'f-?Sz`!- 3&oy District: iC�1s� y <br />Station Address: 2320 N, t;(-DDrzA00 ST. <br />S7aU�TD�J a C� . <br />Purpose of Visit: j:A nj K TesT <br />............:............. <br />SPIL .:B XES <br />U <br />Product <br />Product <br />Type <br />Overfill <br />Condition <br />Stick Shield <br />Drain Operational? <br />SU <br />E6Vj <br />Flapper <br />G(e,�,,., <br />Yes No <br />RU <br />Type <br />E13a) <br />eAZ ,,w% <br />C,� 5 inches <br />-'Yes No <br />REG <br />/ <br />G 6Vj <br />RU <br />�(-e_ <br />---Yes No <br />Yes -No <br />u. REG <br />inches <br />1ptoaf <br />Yes No <br />DSL <br />inches <br />Yes No <br />r: <br />• ARE PRODUCT IDENTIFICATION TAGS/COLLARS INSTALLED? ✓YES ;,/'NO <br />e TURBINE TYPE: Cathodic Protective Enclosed Sacrificial Annode <br />�-Secondarily Contained Unprotected <br />ADDITIONAL REMARKS: %�� `L 5K TDP.y�`8 �: c�.�►^ f�cC(5 �o i g'�� ((C c(7, <br />I certify the above measurements regarding fill tube distances are c r ct. <br />GGt� <br />SIGNATURE <br />COMPANY -r-- <br />7- <br />DATE <br />U <br />Product <br />Distance <br />Overfill <br />Condition of Overfill <br />Stick Shield <br />From Tank <br />Flapper <br />Present? <br />Bottom <br />Installed? <br />Type <br />SU <br />C,� 5 inches <br />j <br />/ <br />Yes -No <br />RU <br />inches <br />hr <br />Yes -No <br />u. REG <br />inches <br />1ptoaf <br />o era ,'o a f <br />Yes /No <br />inches <br />Yes No <br />DSL <br />inches <br />Yes No <br />• ARE PRODUCT IDENTIFICATION TAGS/COLLARS INSTALLED? ✓YES ;,/'NO <br />e TURBINE TYPE: Cathodic Protective Enclosed Sacrificial Annode <br />�-Secondarily Contained Unprotected <br />ADDITIONAL REMARKS: %�� `L 5K TDP.y�`8 �: c�.�►^ f�cC(5 �o i g'�� ((C c(7, <br />I certify the above measurements regarding fill tube distances are c r ct. <br />GGt� <br />SIGNATURE <br />COMPANY -r-- <br />7- <br />DATE <br />