Laserfiche WebLink
DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <br />MONTHLY VISUAL INSPECTION CHECKLIST <br />Facility Name <br />Quik Stop Market # 39 <br />�. f '— Date <br />uk <br />February 1, 2017 <br />Facility Address <br />2285 E. Fremont Street <br />k,, K <br />E <br />City, State, zip <br />Stockton, CA 95205 <br />AUG 16 ?.017 <br />Alarm history report / log for the previous month is available, and has been reviewed by the Designated UST Operator. <br />Designated Operator <br />Carpenter, Curtis <br />❑ <br />3a <br />4 <br />ICC Certification # <br />8167865 -UC <br />Expiration <br />February 5, 2019 <br />5 <br />Sensors located in tank -top containment sumps have NOT alarmed in the past month. <br />ENVIRONMENTAL I-P4��--t"�,�.-Ti`I <br />❑ <br />Signature <br />.' � <br />phone <br />(916) 373-1166 <br />Item <br />1Monitoring <br />MONITORING PANEL / ALARM HISTORY <br />system is powered on and in proper operating mode. <br />Y <br />■ <br />N <br />❑ <br />NA <br />❑ <br />2 <br />Monitoring system is NOT currently showing any alarms or warnings. <br />E <br />❑ <br />❑ <br />3 <br />Alarm history report / log for the previous month is available, and has been reviewed by the Designated UST Operator. <br />0 <br />❑ <br />❑ <br />3a <br />4 <br />Is a copy of the alarm history report/log to this form? <br />Each alarm for the previous month has been responded to appropriately. <br />❑ <br />❑ <br />❑ <br />❑ <br />0 <br />5 <br />Sensors located in tank -top containment sumps have NOT alarmed in the past month. <br />❑ <br />❑ <br />5a <br />List all tank -top sumps where alarms occurred in the past month: <br />Note: Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to, and <br />properly addressed, the cause of the alarm. Attach documentation verifying appropriate service to this report. <br />If sum ins ection is re uired, record results in item 6, below. <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: ❑ ❑ <br />Sump Location: ❑ ❑ <br />Sump Location ❑ ❑ <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />Y I N INA <br />Tank 1 - Gasoline 87 0 ❑ ❑ <br />Tank 2 - Gasoline 91 E ❑ ❑ <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N NA <br />Dispenser 1 /2 ■ ❑ ❑ <br />Dispenser 3 / 4 ■ ❑ ❑ <br />® 2017 E ,., - Page 1 Checklist P1 <br />