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DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR MONTHLY VISUAL INSPECTION CHECKLIST me Quik Stop Market #1 Date July 10, 2017 dress 1153 Lincoln Blvd.PiECEIVED , zip Tracy, CA 95376 d Operator Harold Largo Q C T 2 0 2017 Lsignature ication # 8293993 Expiration November 4, 2018 ��-/� o7 ( Phone (916) 373-1166 MMM MONITORING PANEL / ALARM HISTORY Y N NA ing system is powered on and in proper operating mode. ■ ❑ ❑ing system is NOT currently showing any alarms or warnings. ❑ ■ ❑istory report / log for the previous month is available, and has been reviewed by the Designated UST Operator. ■ ❑ ❑ copy of the alarm history report /log to this form? ■ ❑ ❑larm for the previous month has been responded to appropriately. [77h ❑s located in tank top containment sumps have NOT alarmed in the past month.ll tank -top sumps where alarms occurred in the past month: Note: Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to , and properly addressed, the cause of the alarm. Attach documentation verifying appropriate service to this report. If sum ins ction is re wired record results in item 6 below. UST SYSTEM INSPECTIONTank __ top cont sumps are free of water, debris, and hazardous substance. Sensors are located properly._Note: Visualn of sumps is only required in sumps where an alarm has occurred in the past month for which there is no service record. Y N Y NSump Loca❑ ❑ Sump Location: ❑ ❑Sump Loca❑ ❑ Sump Location: ❑ ❑Sum Loca❑ ❑ Sum Location: �? ❑ ❑ 7 Spill Containructures are free of water, debris, and hazardous substance.Y 7/4 N NA Y N NA Tank 1 - ■ ❑ ❑ Tank 3 - 91 ■ ❑ ❑Tank 2 - ■ ❑ ❑8 Under-dispentainment areas are free of water, debris, and hazardous substance. Sensors are located properly. Y N NADispenser ■ ❑ ❑Dispenser ■ ❑ ❑ ® 2017 r E.�:.: _._- Page 1 Checklist P1