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DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <br />MONTHLY VISUAL INSPECTION CHECKLIST <br />Facility Name <br />Quik Stop Market # 39 Date December 1, 2016 <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 March 20, 2015 <br />Signature Phone (916) 825-7857 <br />UST SYSTEM INSPECTION _ <br />�- <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 />YN <br />Sump Location: El [ISump <br />Location: ❑ E3 <br />Sump Location D... <br />ip <br />_ ..El _ <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />Y N NA <br />t <br />U G 16 20 <br />Tank 1- Gasoline 87 E El ElA <br />Tank 2 - Gasoline 91 E ❑ ❑ <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensgr�,W l9gaJed,prp{ (IY H E LTH <br />Y N NA'�`�e <br />Dispenser 1 / 2 ❑ ❑� <br />'T <br />Dispenser 3 / 4 ■ ❑ ❑ <br />02016 E—,,~- Page 1 Checklist Pl <br />