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DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <br />MONTHLY VISLIAL_INSQEMON CHECKLIST <br />Facility Name Quik Stop Mark" V.— %."F 1 V G L, Date May 10, 2017 <br />Facility Address 1153 Lincoln Blvd. <br />City, State, Zip Tracy, CA 95376 0C.r 2 0 2017 <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: El ElSump Location: <br />Sump Location: 11 E]Sump Location: <br />Sump Locations El El Sump Location <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />Y N NA <br />Tank 1 - 87 ■ ❑ ❑ 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 112 ■ ❑ ❑ <br />Dispenser 3/4 0 ❑ ❑ <br />mom <br />Y N NA <br />■ ❑ ❑ <br />0 2017, ;, Page 1 Checklist P1 <br />