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DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <br />MONTHLY VISUAL INSPECTION CHECKLIST <br />Facility Name <br />Quik Stop Market # 39 Date November 7, 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 16, 2017 <br />Signature <br />Wit" .,--- Phone (916) 825-7857 <br />G< <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 />YN <br />Sump Location: ❑ ❑ <br />Sump Location: E3❑ <br />Sump Location.❑ ❑ <br />Lim <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. u <br />Y N NA <br />Tank 1 - Gasoline 87 0 ❑ ❑ <br />Tank 2 - Gasoline 91 N ❑ ❑ <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. T <br />Y N NA_ ,;H EA <br />Dispenser 112 0 11 E] �T <br />Dispenser 3/4 N ❑ ❑ <br />® 2015 ,,,-,-- - Page 1 Checklist P1 <br />