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DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <br />MONTHLY VISUAL INSPECTION CHECKLIST <br />Facility Name <br />Quik Stop Market # 39 Date June 1, 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 Expiration February 6, 2019 <br />Signature <br />Phone (916) 373-1166 <br />LIST SYSTEM INSPECTION <br />6 --Tank" top containment_ sumps are free of water, debris, and hazardous substance. <br />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 />YL,_t <br />Sump Location: <br />❑Sump <br />Location:❑� <br />Sump Location: <br />E3 <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />AUG 1 2017 <br />Y <br />N <br />1 - Gasoline 87 <br />0 <br />ElTank <br />INATank <br />2 -Gasoline 91 <br />N <br />El <br />E —Na <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. ensors ar <br />Y N NA <br />DEPARTMENT <br />Dispenser 112 0 ❑ ❑ <br />Dispenser 3/4 N ❑ ❑ <br />®2017,,,,_,,8 Pagel Checklist PI <br />