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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 April 3, 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 5, 2019 <br />Signature <br />- - <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 NOtt <br />r <br />Sump Location: El E],,11 <br />Sump Location: ❑ ❑ka <br />R E <br />,.,, v' <br />Sump Locations D 0 <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. aU G 011 <br />YN NA <br />Tank 1 - Gasoline 87 ■ ❑ 1:1Tank 2 Gasoline 91 M C] ❑ <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Seo he,lprt�d�xoserly. <br />Y N NA !.11 <br />Dispenser 112 0 ❑ ❑ <br />Dispenser 3 / 4 N ❑ ❑ <br />Q 201 � `;.. - Page 1 Checklist PI <br />