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DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <br />MONTHLY VISUAL INSPECTION CHECKLIST <br />Facility Name <br />Quik Stop Market # 39 <br />Date August 7, 2017 <br />Facility Address <br />2285 E. Fremont Street <br />Y N�, <br />Sump Location: E] El <br />City, State, zip <br />Stockton, CA 95205 <br />Designated Operator <br />Harold Largo <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />ICC Certification # <br />8293993 <br />Expiration November 13, 2018 <br />Signature <br />'q- G 7 <br />Phone (916) 373-1166 <br />UST SYSTEM INSPECTION <br />6 Tank top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly <br />Note Visual inspection of sumps is only required in sumps where an alarm has occurred in the past <br />m r}11C1' nc�re <br />Y N�, <br />Sump Location: E] El <br />Sump Location: ❑ ❑ <br />Sump Location: El❑ <br />_..a _. ., - _.... - ._. ,...,_� _ .. <br />.,_ <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />Y N INA <br />Tank 1 -Gasoline 87 ■ ❑ ❑ <br />Tank 2 -Gasoline 91 ■ ❑ ❑ <br />N1 <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. <br />Sensors are located properly. <br />Y N NA <br />Dispenser 112 ■ ❑ ❑ <br />Dispenser 314 ■ ❑ ❑ <br />2 <br />® 2017 r E;,,_,,,-,; - - Page 1 Checklist P1 <br />