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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 March 1, 2017 <br />Facility Address <br />2285 E. Fremont Street <br />substance. <br />City, State, zip <br />Stockton, CA 95205 <br />Designated Operator <br />Harold Largo <br />NA <br />ICC Certification # <br />8293993 <br />Expiration November 13, 2018 <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 />Sump Location: ❑ ❑ RE <br />a ^, <br />a <br />Sump Location: ❑ ❑ is <br />Sump Location. <br />❑ ❑ <br />7 Spill Containment Structures are free of water, debris, and hazardous <br />substance. <br />A U r y <br />u 1 2 �, <br />Y <br />N <br />NA <br />Tank 1 - Gasoline 87 <br />0 <br />❑ <br />❑ <br />Tank Gasoline 91 <br />■ <br />❑ <br />Cl <br />ENV1R0N1A4i=',l:T- E <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Se r,� &' ed`f pi <br />Y N <br />NA <br />'i., P <br />Dispenser 112 <br />0 ❑ <br />❑ <br />Dispenser 3 / 4 <br />■ ❑ <br />❑ <br />® 2017 W" ­ Page 1 Checklist P1 <br />E..„.,,.. .. 9 <br />