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• <br />• <br />DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR_ <br />MONTHLY VISUAL INSPECTION CHECK _ x i <br />Facility Name <br />Quik Stop Market #126 <br />Date March 3, 2017 <br />Facility Address <br />1580 W. Main Street <br />j J N 13 ?01? <br />City, State, Zip <br />Ripon, CA 95366 <br />Designated Operator <br />Harold Largor��,�!� <br />Ap,t ®@ <br />ExpirFmNVI t"�gOIV�@ITI 113`,`261 $r1 <br />ICC Certification # <br />8293993 <br />❑ <br />Signature-1...tlf <br />/ i L� /fit' <br />Phone J'3=Ifi JT <br />UST SYSTEM INSPECTION <br />6 Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Mote: 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: ❑ ❑ Sump Location: <br />❑ <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 i - Gasoline 87 ■ ❑ ❑ Tank 3 -Diesel <br />❑ ❑ <br />Tank 2 - Gasoline 91 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 0 ❑ ❑ <br />Dispenser 5 / 6 ■ ❑ ❑ <br />FACILITY EMPLOYEE TRAINING <br />15 All facility employees have received the required on-the-job training within the <br />16 All facility employees hired within the past 30 days have received the required <br />YININAI <br />■1111131 <br />®4017 W- Pagel Checklist P7 <br />E- ..... . <br />