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DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <br />MONTHIrY%W8Uftz1N$PFQfflBN CHECKLIST <br />Facility Name Quik Stop Market #135 5® ' ® v ` lilmoff Date January 27, 2017 <br />Facility Address 1153 Lincoln Blvd. O C ( 2 0 2017 <br />City, State, zip Tracy, CA 95376 <br />Designated Operator Carpenter, Curtis <br />ICC Certification# 8167865 -UC ENVIRONMENTAL HEALTH Expiration February 5, 2019 <br />Signature DEPARTMENT Phone (916) 373-1166 <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 />Sump Location: ❑ ❑ 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 N ❑ ❑ <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N NA <br />Dispenser 112 0 ❑ ❑ <br />Dispenser 3 / 4 0 ❑ ❑ <br />Irl <br />Y N NA <br />■ ❑ ❑ <br />02017 ;,,, ;,r, Page l Checklist P1 <br />