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DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <br />MONTHLY VISUAL INSPECTION CHECKLIST <br />Facility Name Quik Stop Market #Ipw. Date February 8, 2017 <br />Facility Address 1153 Lincoln Blvd. H� � � �� <br />City, State, zip Tracy, CA 95376 <br />Designated Operator Harold Largo OCT 2 0 2017 <br />ICC Certification # 8293993 Expiration November 4, <br />2018 <br />Signature/�.-r� P� Phone (916) 373-1166 <br />QFEWA <br />MONITORING PANEL / ALAR TORY <br />Y <br />N NA <br />_ _ <br />ring system is powered on and in proper operating mode. ,,<,:. <br />■ <br />❑ ❑ring <br />system is NOT currently showing any alarms or warnings. <br />■ <br />❑ ❑history <br />report / log for the previous month is available, and has been reviewed by the Designated UST Operator. <br />■ <br />❑ ❑copy <br />of the alarm history report /log to this form? <br />■ <br />❑ ❑larm <br />for the previous month has been responded to appropriately. <br />❑ <br />❑ ■ <br />rs located in tank -top containment sumps have NOT alarmed in the past month. <br />[::an <br />■ <br />❑ ❑ <br />all tank -top sumps where alarms occurred in the past month: <br />Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to, and <br />properly addressed, the cause of the alarm. Attach documentation verifying appropriate service to this report. <br />If sum ins ection is re wired record results in item 6 below. <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 />Y <br />N <br />Sump Location: ❑ ❑ Sump Location: <br />❑ <br />❑ <br />Sump Location: ❑ ❑ Sump Location: <br />❑ <br />❑ <br />Sump Location: ❑ ❑I'll Sump Location: <br />(] <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />Y N NA <br />Y <br />N NA <br />Tank 1 - 87 ■ ❑ ❑ Tank 3 - 91 <br />■ <br />❑ ❑ <br />Tank 2 - 89 ■ ❑ ❑ <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 ■ ❑ ❑ <br />Dispenser 314 ■ ❑ ❑ <br />FACILITY EMPLOYEE TRAINING Y N I NA <br />15 All facility employees have received the required on-the-job training within the past year. ❑ 01 ❑ <br />116 All facility emolovees hired within the past 30 days have received the required on-the-job training. ❑ ❑ ■ <br />0 2017 � ;,,,_, 1-- Page 1 Checklist P1 <br />