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DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <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 />Y N <br />Sump Location: ❑ ❑ Sump Location: <br />Sump Location: ❑ ❑ Sump Location: <br />_WwmmSump Location: 11 ._El.. SumP Location: <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />Y N NA <br />Tank 1 - 87 0 ❑ ❑ Tank 3 - 91 <br />Tank 2 - 89 0 ❑ ❑ <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N NA <br />Dispenser 1/ 2 0 ❑ ❑ <br />Dispenser 3 / 4 ■ ❑ ❑ <br />Y N <br />❑ ❑ <br />❑ ❑ <br />Y N I NA <br />■ ❑ ❑ <br />FACILITY EMPLOYEE TRAINING Y I N I NA <br />15 All facility employees have received the required on-the-job training within the past year. ❑ ❑ <br />16 All facility employees hired within the past 30 days have received the required on-the-job training. ❑ 1 ❑ 1 0 <br />02016 E-1-,h;,H Pagel Checklist P1 <br />MONTHLY <br />T ECKLIST <br />Facility Name <br />Quik Stop Market #138 <br />Date October 14, 2016 <br />Facility Address <br />1153 Lincoln Blvd. <br />O C i 2 0 2017 <br />City, State, zip <br />Tracy, CA 95376 <br />Designated Operator <br />Carpenter, Curtis <br />ICC Certification # <br />8167865 -UC <br />ENVIRONMENTAL HEALTH Expiration March 16, 2017 <br />Signature�- <br />`--- <br />EPARTMENT Phone (916) 825-7857 <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 />Y N <br />Sump Location: ❑ ❑ Sump Location: <br />Sump Location: ❑ ❑ Sump Location: <br />_WwmmSump Location: 11 ._El.. SumP Location: <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />Y N NA <br />Tank 1 - 87 0 ❑ ❑ Tank 3 - 91 <br />Tank 2 - 89 0 ❑ ❑ <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N NA <br />Dispenser 1/ 2 0 ❑ ❑ <br />Dispenser 3 / 4 ■ ❑ ❑ <br />Y N <br />❑ ❑ <br />❑ ❑ <br />Y N I NA <br />■ ❑ ❑ <br />FACILITY EMPLOYEE TRAINING Y I N I NA <br />15 All facility employees have received the required on-the-job training within the past year. ❑ ❑ <br />16 All facility employees hired within the past 30 days have received the required on-the-job training. ❑ 1 ❑ 1 0 <br />02016 E-1-,h;,H Pagel Checklist P1 <br />