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0 <br />0 <br />DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <br />MONTHLY VISUAL INSPECTION CHECKLIST <br />FacI14 Name <br />Quik Stop Market #144 Date October 5, 2015 <br />Facility Address <br />7272 West Lane <br />City State, Zip <br />Stockton, CA 95210 <br />Desgnated Operator <br />Carpenter, Curtis <br />ICC Cerfilicabon # <br />8167866 -UC Expiration March 16, 2017 <br />Sigrature <br />- Phone (916) 826-7867 <br />I Item <br />- 1 <br />MONITORING PANEL / ALARM HISTORY <br />Monitoring system is powered on anc I - n proper operating mode. <br />Y <br />N <br />N <br />Cl <br />NA] <br />0 <br />2 <br />Monitoring system is NOT cLaenthy showing any alarms or warnings- <br />N <br />D <br />G <br />3 <br />Alarm history report I to for the ;xevious month is available, arA has been reviewed by the Designated UST Operator. <br />Y N KA LL <br />Dispenser 112 0 11 13 <br />Dispenser 314 0 11 ❑ SEP 01 2016 <br />3a <br />is cosy ofthe &farm history report liogto this Amm? <br />07130115 <br />0 Q <br />0 <br />4 <br />Each alarm for the prevnus month has been responded to appropriately <br />: 0 0 <br />5 <br />Sensors located In lank -top containment suirips have NOT alarmed in the post month. <br />� <br />0-4 0 <br />N <br />511 <br />Lid all lank -fop sumps where aWms occurred In the post month, <br />04128119 <br />1 <br />13 I 1011 <br />El <br />AVOW —S-u—mo where —an &Isnn has *-cvu—mad -f n- -tr-,# past —rwv4h must bt m-spected unles3 a quakfied servc'- tscftrt�sm responded to and <br />proper* addivsSeA ft ca ust of J" jatrrn, Aftach 1w0n)wta#o11 veAlYng 80NOWdstc 50nive b this repw <br />N sum rnApe0on m npquAmd mccfd results ia dem 6 b0ow, <br />r UST SYSTEM INSPECTION <br />6 Tank -top containment sumps are tee of water, de" and hazardous substance Sensors are located property. <br />MOM 14'suaograsper -2r otsumcsis only fv-W'redir sumps w4are an aiefm has occurred in the P*V rwnth for whch there is F -EP service record <br />YN <br />Sump Location, - 0 1:1 <br />SUMP Location: 13 0 <br />Location l <br />1 Sumpwa: 0 <br />- , - , <br />7 spill C ontai nment Structures are free of water, debris. and hazardous substance, <br />Y N NA Y N NA <br />Tank I - Gasoline 87 a [3 [1 -rank J - Gasofirre 91 N Cl 0 <br />1 <br />Tank 2 - Gasahe 89 0 11 01 <br />8 Under -dispenser containment areas are free of water, debris, and hazardous sLtstance. Sensors are tocated property, <br />Y N KA LL <br />Dispenser 112 0 11 13 <br />Dispenser 314 0 11 ❑ SEP 01 2016 <br />Dispenser 516 0 0 ❑ <br />Spill conlainnierd structure (btoell) testing wascompleted Whin the Past year, <br />07130115 <br />0 Q <br />0 <br />12 <br />Tank tightness testing was completed within the required limeframe. <br />9 <br />PAPERWORK INSPECTION <br />Monitoring sysiom cerimeavon has been completed within the past 12 months. <br />Date <br />07130115 <br />Y N <br />0 0 1 <br />NAI <br />E31 <br />is <br />Secondary containment tests have been compefed within the required timeframe. <br />09117113 <br />N Q <br />Q <br />1-- <br />Spill conlainnierd structure (btoell) testing wascompleted Whin the Past year, <br />07130115 <br />0 Q <br />0 <br />12 <br />Tank tightness testing was completed within the required limeframe. <br />: 0 0 <br />13 <br />Line tightness testing was completed within the required timeframe. <br />� <br />0-4 0 <br />N <br />14 <br />Other required testing maintenance was completed within the requirec firneframe. (List items b"w)— <br />Testlualmenance Air Malky Test <br />04128119 <br />1 <br />13 I 1011 <br />El <br />FACILITY EMPLOYEE TRAINING <br />_eft15 AN facility employees have received tr"uiree on-the-job lr�irung withiq the past year <br />Y I N <br />i 0 <br />INA <br />0 <br />16 <br />All facility e�,�ees hired within t-&rie F2$1 30 daysjuve received the required on-the-job tralMng. <br />o 1 n <br />I m <br />