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DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR MONTHLY VISUAL INSPECTION CHECKLIST Facility Name Quik Stop Market#144 Date July 7,2011 Facility Address 7272 West Lane City,State,Zip Stockton,CA 95210 Designated Operator Powell,Ryan ICC Certification# 5257345-UC Expiration March 15,2013 Signature �sja .. .- —-� Phone (916)869-0039 E MONITORING PANEL / ALARM HISTORY Y Noring system is powered on and in proper operating mode.ring system is NOT currently showing any alarms or warnings. ■ ❑ ❑ history report/bg for the previous month is available,and has been reviewed by the Designated UST Operator. ■ ❑ ❑copy of the alarm history repot/log to this form? ■ ❑ ❑alarm for the previous month has been responded to appropriately. ■ ❑ ❑ rs located in tank-top containment sumps have NOT alarmed in the past month. ❑ ■ ❑ t all tank-top sumps where alarms occumad in the past month: STP sump/fuel alarm on July 3.2011. 77 : Sumps whew an alarm has occurred it the peat morroh must be inspected unless a quallfted service techrdcian responded to,and properly addressed,the cause of the alarm. Attach docurtemtatlon verifying appropriate service to lfft report N sump inapection is mouired,record rem/ts it Rem a below. UST SYSTEM INSPECTION 6 Tank-top containment sumps are free of water,debits,and hazardous substance. Sensors are located property. Note. Visual Inspection of sumps Is only mquied tiny sumps an alarm has occurred In the past month for which there is no service record. Y N Y N Sump Location: ❑ ❑ Sump Location. ❑ ❑ Sump Location: ❑ ❑ Sump Location: ❑ ❑ Sump Location. _ ❑ ❑ Sump Location: ❑ ❑ _ 7 Spill Containment Structures are free of water,debris,and hazardous aubstence. Y N NA Y N NA Gasoline-sty ■ ❑ ❑ Gasoline-91 ■ ❑ ❑ Gasoline-89 ■ ❑ ❑ ❑ ❑ ❑ 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located property. Y N NA Y N NA Disp 1-2 ■ ❑ ❑ ❑ ❑ ❑ ` Disp 3-4 ■ ❑ ❑ ❑ ❑ ❑ Disp 5-6 ■ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ O O ❑ PAPERWORK INSPECTION Dale Y N NA 9 Monitoring system certification has been completed within the past 12 months. 08/02/10 ■ ❑ 10 Secondary containment tests have been completed within the required timeframe. 09/2$/10 ■ ❑ ❑ 11 Spill containment structure(bucket)testing was completed within the past year. 08/02/10 ■ ❑ ❑ 12 Tank tightness testing was completed within Mui required timeframe. ❑ ❑ ■ 13 Une tightness testing was completed within the required timefrarrhe. ❑ ❑ ■ 14 Other required testing/maintenance was completed within the required timeframe. (List items below) Test/Maintenance Air Quality Test 04/26/11 ■ ❑ ❑ Test/Maintenance 1 01 01 ❑ FACILITY EMPLOYEE TRAINING Y N NA 15 AN facility employees have received the required on4h&4ob training within the past year. ■ ❑ ❑ 16 All facility employees hired within the past 30 days have received the required on-the-job training. ❑ ❑ ■ a►s�7 E �_ Pop 1 chlokilst P1