Shell Gas Station Monitoring Form Your Name Date Street address City State Zipcode E-mail Telephone Fax Please use this form to let us know about service (good or unsatisfactory) you encountered at a Shell station. This information will be used to ensure that stations covered by the Consent Decrees in Greener v. Shell are accessible according to the terms of the settlement agreement. Station Information: Street Address: City: State: Date and Time of Visit: Please describe the service that you encountered at the gas station: At the pumps.
Did you encounter any barriers to independent use of pumps and card readers (e.g., could you reach the card reader)?
No Yes If yes please explain.
Was there a sign stating how you could get help pumping gas or activating the pumps?
No Yes
Did you have any problems getting help pumping gas?
In the convenience store. Were there any problems with service in the store?
No Yes. If yes please explain At the cashier windows. Did you have any problems at the cashier window?
No Yes. If yes please explain Toll Free Number Was there a sign for a toll free number to call Shell with your comments about service?
Did you call?:
Comments about the toll free comment line service: Additional Comments. Is there anything else we should know about service at this Shell station?: This will erase all of your input. Back to DREDF 12/10/00
