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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 July 5, 2017 <br />Facility Address <br />2285 E. Fremont Street <br />City, State, zip <br />Stockton, CA 95205 <br />Designated Operator <br />Carpenter, Curtis <br />ICC Certification # <br />8167865 -UC <br />Expiration February 6, 2019 <br />Signature <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 month for which there is no service record. <br />Y N , *. <br />Sump Location: El 11 <br />Sump Location: ❑ ❑k�g <br />Sump Location: ❑ ❑ <br />_. _...._._. .._ ......... <br />a .... _ ----- .... <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />Y N NA <br />Tank 1 - Gasoline 87 ❑ ❑ <br />Tank 2 - Gasoline 91 0 ❑ ❑ <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensr.are� located properly <br />Y N NA i <br />Dispenser 1 / 2 ■ ❑ ❑ <br />Dispenser 3 / 4 E ❑ ❑ <br />FACILITY EMPLOYEE TRAINING Y I N I NA <br />15 Ali facility employees have received the required on-the-job training within the past year. ❑ ❑ <br />16 All facility emolovees hired within the past 30 days have received the required on -the -lob training. ❑ ❑ <br />02017 Y E,,,_'- r . . - Page 1 Checklist P1 <br />