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NO <br />DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <br />MONTHLY VISUAL INSPECTION CHECKLIST <br />Facility Name <br />Quik Stop Market # 39 <br />Date September 7, 2016 <br />Facility Address <br />2285 E. Fremont Street <br />City, State, Zip <br />Stockton, CA 95205 <br />Designated Operator <br />Harold Largo <br />ICC Certification # <br />8293993 <br />Expiration December 18, 2016 <br />Signature/- <br />I <br />Phone (916) 373-1166 <br />UST SYSTEM INSPECTION <br />—Tank -top containment sumpsare free of water, debris, and hazardous —substance. —Sensors are loc—a,t,e�-d-properly. <br />",----,— <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 />I N <br />Sump Location: <br />Sump Location: El El <br />Sump Location: F-1 El R <br />. .........I- <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />Y N NA <br />Tank I Gasoline 87 0 � El E01 <br />Tank 2 El <br />Gasoline 91 0 <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substan&-rug JrrVrd6tAW6W1T_' <br />Y N NA I hx;r <br />Dispenser 1/ 2 N El El <br />Dispenser 3 / 4 E El E] <br />02015 Page 7 Checklist P1 <br />