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CINDER ROUND STOP A,G TANK SYSTEM <br /> DESIGNATED QST .4PERAT (?R. MONTHLY INSPECTION REPORT <br /> Facility' Named Tokay,Shell IiispectiowDate,.. <br /> Facility Address: . .420 N . Keffleman lane City:• Lodi , Cq 1 <br /> •Name of Designated UST Operator Conducting' lnspection : <br /> All- <br /> Inset national Code .Couticil Certificatiou'No: t . Expiration-Date: <br /> Signature? Phonei : 1371 -2380 ;exi; j <br /> :N/A.= NoCAP01cable <br /> Item- IV)it?NITORING .PAN1aL I. AL,ARMHISTORY Yes ;No. N/A <br /> 1 . Is the inoriitoiiri 's stem oyVered on`ar}d. ui ".ro "ex:o .•statin i�tide7 ❑ ❑ <br /> IIIIIIII <br /> 2 : Zs:th0.monitbNri s stQni .net cuikentl ' sh6iviii pari' Teak alarm's?: ❑ <br /> 3 , Is;tte Alacn�i, ITlstory Repo /log for°the previous• mRntit :avaiiable,. and has it:been reviewed by the ❑ i <br /> Desi natetl UST 0 eratoi7 Adach a copy,---of The alarin htsto .re or!/!o fo. 'this ins eclionorm. j <br /> 4 . Has :eaoh •a}aiom .for the ' revioiis inontli. been ies ofided to. aopro riatel 7 ❑ j <br /> I INT SYSTPW INSPECTION` . i <br /> 5 . :Are tankytop containment sumps fiee- of water; debris, and hazardous. substancel -Natoi °-# 'the ansivgr. ro. Jrem :9 wus "Ail ktp l <br /> ld IJem 6' sumps itiNre an alae'ni hds occurred (n IGe puss M tit Titus( & J�iipecled Ita gualot f Seryke lec111110 W has nol:respgndad to. and <br /> Toper add♦`esse ilia cause 101 the alai iu. Docunretitailot�.Yer in ro rlatesetv/ce sfiotrld'be altached lo:lhfs.re .0n, <br /> Yes .No . 1111111Yes: No' <br /> r. Sum ' 'Location: Sum Location: <br /> Nil <br /> Sump Location <br /> 6. Ate spill buckets containment structures free of'water; debris • and hazardous substance? <br /> r Yes No `N%A . Yes. NO. N%A <br /> Tank l 1D I n wl ❑ I Tank 4 iD <br /> Tank 2 ID _ ❑ ❑ . Tgnk 5 lD - <br /> :.:: .Tank •3' IDElTank 6 TD . ❑ <br /> 7. Are under dis enser.• cpntainment areas .free of water, debris, and hazardous substance?: I <br /> Y_es . iVb'. N/A . Yes No N/,A, <br /> Dispenser= 172 0 Is . Q' bis enser —.9/10 �, <br /> Dispenser.. 3/4 ❑ ❑ Dis enser -- ` <br /> Disenser- 5/6: ❑ ❑ Dis enser ❑ - U ESj <br /> pispensei: = 7/8 ❑ ❑ pis enser - ❑ ❑ ; 1 <br /> $, Leak detection ispr6oerly located within under-.dispenser .contaiiiment: . <br /> Yes No :TT/A. . . 'Yes I No. N/A <br /> Dispenser - 1!2 ❑ Dis enser - 9/ i0. ;❑ ' <br /> »is' enser, 374 [] ❑ . Dis enser•— <br /> Us' <br /> enser — 5/6` ❑ ❑ Dis enser <br /> I . Dispenser:= .. _ . .. <br /> i t .€' ! - 7= ': ;fii ; in" ="hn "r ._ _ - lip tl ' ,.,.-a 7 ' �.i °• - i_E ::.r+.F, ! `•.I'� : _ ' ,aifi�'s"� . .ei . ;i(I ['.'� <br /> v PAPERWORK INSPECTION rt . Yes No N/A 1t)ntA rr�r . . <br /> 9 . .Monitorin S stem :Certtificationwascoin leted .withinfhe ast.`12 .inonths7 ❑ ❑ . ' t <br /> .10: gine Leak:l?et6otoM were tdsted/ceitifie0 within the ; pas11 .12 ,inbntht?, ❑ : ❑ ��;� , <br /> 1 I . Sill bucket c6tita[iimerit struetiq.e testin ' 'gO00ieted_ within the. ast 12 months? ! <br /> ❑ <br /> 12. . AA 'ti htrless testiri ' 0h! letedWthiu the required timeframe? ❑ = El IIS I <br /> G �~ <br /> 13. S¢cbnda .' conWnmenl tests com feted within the re uired ,time 'frame? , El IF 1 �19-2016 <br /> 14, Enb4nPed .Leak' Detecfon corn leted within the required the :frame? ❑ El <br /> 15; 'Other requilged testhi maintenance was, com leted :within tequired :timbI traine? (. . test./maintenance items below. <br /> D'ascribe �Test(Wintenancc: Aii- . uali : I VA ot` recove. 917-201 <br /> Describe Test/lvlainteiiatice: El : f 1 <br /> FACILITXAMPLOYEE TRAINING Ye§ No . .N/A i <br /> 16 . *Have all facilif :em , Io ees received ttie.re uired .oti=the= ob :tralning ti?ithin.the :ast eai ? ❑ <br /> 17. Haire all facifi :em loyees hired Within the ast:30 :da s received there uived on=the='ob trafiiingl <br /> tihvcv.unldocs.oi'g 9hG/(IS <br /> - I <br />