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DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <br />MONTHLY VISUAL INSPEC] QW CHECKLIST <br />Facility Name Quik Stop Market 4M I V " V Date December 12, 2016 <br />Facility Address 1153 Lincoln Blvd. <br />City, State, Zip Tracy, CA 95376 Q C T 2 U 2017 <br />Designated Operator Harold Largo <br />ICC Certification # 8293993NVIRQNMENTAL HEALTH Expiration uecemner i a, Zu1 b <br />Signature _4. � o ,17 "�_ DE-PARTMENT Phone (916) 373-1166 <br />UST SYSTEM INSPECTION <br />4 .0 m� , _ ... x� <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 />Sump Location„ ❑ ❑ Sump Locahon.K <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />Y N NA <br />Tank 1 - 87 N ❑ ❑ Tank 3 - 91 <br />Tank 2 - 89 M ❑ ❑ <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 NA <br />■ ❑ ❑ <br />02016 W'„ ; .,;r Page 1 Checklist PI <br />