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Ito UNDERGROUND STORAGE TANK SYSTEM DESIGNATED UST .OPERATOR MONTHLY INSPECnON REPORT 1 FaoilityNaine: Tokay;Shell Inspection: Date;.. .. . & . .- ::� Facility Addreoi`ss: " .`420 N . Kettleman Dane City: Lodi, Cq 1 'Name of Designated UST Operator Conducting' ln4pection: Internatio-ial Code "Council Cerdfication 'Nq:.c . Expiration-Date: 41 ,42 o .- -� o . Signature; Phone; : (9'16) 371 -2380 ext; . . :N/A.= No(Applicable 1<tein 1VXQNITORINGPANEI� I. AIJARM .HISTORY Yes :No. N/A I . Is .theinonitoiin $ st. Q t . , QWeredomarid-. in '.ro "er :o eratiri ilnode? 2 : ts:the: monitorin s steni .ndt currents :showiii 'ap Teak alarjns?: ❑ 3 , Is:t re Alartti. History Repoa /]og for`ttie previous. month availible, . andI s itbeen reviewed .by-the ❑ i Desi nated UST 0 erator ? Ada h. co o the alarm histo .re orf!!o to this ins ection arm.) j 4. Has :eadh 'alariii .for the revious month been ids o4lided tod appro riatel 7 ❑ ` t . jail # UST SYSTEM INSPECTION` ` r I 5 . ;Are tank top containment sumps flee" of water;' debris and hazardous. substance? Noloi 'tfihe aistver:iolren, 'd tvus"',X,esr" sinp ' pp to Reiss 6 sumps where an alarm hds occurred ln` ihs pasqualrid service im i1c(dn Ings not:respondedod to, and j io "er kddt'esse�! tha 'rause o the atp,'iu. Docrrme8lglio+.�•Yer ' ih a r. rtatesetvlce sliould'De oitached toahis-re .ort, Yes No • Yo kes ] No Sum ' f Qcatton: ❑ . `E Sump ' um Location: ❑ r Sunjp Location: ❑ 11 ❑ & 1 Sum Location; 6. Ares ill buckets. (containment strud flee of'water; debris-• and bazardous stibstfiuce? ' f ')tes No 'N/A . Yes. I NO. I N/A Tank 1 ID — ❑ I Tank A ID — ❑ . + Wood Tank 241) — ❑ ❑ , I Tank 5 IDF,.. Y I aitk 3 .ID ❑ ❑ Tank 6 ID EI ❑ i 7. Are under"dispenser containment areas .free of Water, debris, and hazard us JoLtanteol ;`=` Yes . I' dC N/A. Xfts4 u4 49 N/A Dispenser 1 /2 ❑ , . ❑' Dis enser —.9/11) IQU El i Dispenser — 3/4 ❑ El ❑ Dis enser — ` i } UP N Dis enser— 'S/6. ❑ ❑ D UP enser c "? < IN j ❑ 1 Dispenser. - .76 /81 Dispense i , , ❑ ; yll [] $, Leak detection is :pt6perly Iodated within under-.dispenser .contalitment: . Yes No :N/A• E, ,�, Yes No. N/A Dispenser - 1/2 ❑ Dispenser - 9/ 1 t). ; - F . x f ❑ j Dis' enser 3/4 ❑I " Dis enser' - ❑ ❑ . li ' Displ enser - 5/6' ❑ ❑ Dis epser . ❑ . doodood . Dis' _eriser - 7/8' ❑ Dis ensei := ❑ '[ :H n'..�?s , ! `"✓� H. t . . � . .i n ? . 1 -.'..�a . T T;, r. td p�:a�s.' (r''.J{.-.'•„' . . .�F� _ _ _ 1 APERWURK INSPECTION Yes No N/A ED04 &lane . . 9`. . Monditorin S stem :Certifrcationwas com leted .wfhe ithin' ast:l2 .inonths? ❑ El '• : 10: , :Line Leak Detectors were tested/certified withintLie ; ast 12 months? ❑ : ❑ � lI . S iiI bucket (cotitainmerit shuctiue) testing` coin' 'idted withitl .the. ast 12 months? FS tu • ❑ . Cie doodl2. . :Ltrie ti ht iess testiii J. o.n letadwithin the re uired timeframe? ❑ ❑ IN I , r 13, 'Secbrida . ' containment tests completed within the re uiredtime frame? . ❑ 119-2015 A Enhanced .Leak' Detection com leted-within the re tiiredtiinelramdO ❑ I ❑ 15 : 'Other required testhi mainfenanee was* corn leted :within required3ime: frame? (List 'test/tna tztendnce itenis• below.) Describe Test/Maintenance: AW Quality % Va be recovery Lj I [j * 1 A7-201 'x' D:escrtbe Test/Maintenatices ❑ ❑ f . �' .' iJ:r Arta4 •vn:_:�nJdl ( .� ' u_ ., "..: . . > . _� - . :. ' �. ii} 'u'.4i5S- . .tJHkJc='r-' ,E€ i>�" i1' r £•. f4 t kA'CII:ITY ,EMPLOYPE TRAINING t # 16 . 1 'Have all facilit : em , lo ees received -the.reuired -o0,ddthpjo training rvitl>in-them t eah ' ❑- 17 . Have all facifi .em la ees hired within the ast:30 .da s received there hired otl=the"ob trainin .7 - --- -- ' -- www.unidoccorg G§ a;`