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DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <br />MONTHLY VISUAL INSPECTION CHECKLIST <br />Facility Name <br />Quik Stop Market # 39 Date October 12, 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 />._._.. Phone (916) 825-7857 <br />UST SYSTEM INSPECTION <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 />Y N <br />Sump Location: ❑ ❑ <br />v " '� <br />� .� <br />Sump Location: ❑ ❑ <br />� y <br />Sump Location: ❑ ❑ <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />A 16 Z017 <br />AUGY <br />N NA <br />Tank 1 - Gasoline 87 ■ ❑ ❑ <br />Tank 2 - Gasoline 91 N ❑ ❑ <br />— <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substanSe \Sehs6 a 'loeaW 6 rl . <br />Y N NA <br />"M71 --NIT <br />Dispenser 112 0 ❑ ❑ <br />Dispenser 3 / 4 E ❑ ❑ <br />Q 2015, ,.,,. w Page 1 Checklist P1 <br />