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11/06/2007 16:11 FAX 2093683234 GEORGE KISHIDA INC 11004 <br />, <br />Designated Underground Storage Tana (UST) Operator <br />,,.�.. Monthly Visual Inspection Checklist <br />Facility Name: Date: 2 Z? D <br />Faci#i Address; <br />Ci Zi Code <br />ilesi r Conductin the >:m►s ection:Ke i s n <br />International Code Council Certilfteation #5 2 4 9 0 Z 7 — U CEx iration Date: 10 111 _1_0. . <br />5i stare: Phone 9 369,::6605 . <br />Y — Yrax N - No NA ` Not ApoGcabte <br />Item' MONITORING PANEL / ALARM HISTORY N NA <br />Y <br /># Monitodn s areas is Bred oa and is EMM OPE Eau" mode. <br />2 Monitor' stem is not curaezmtl s an aiarrmms or waenip . <br />3 Alarm history repomog for the previous month is available, and has been reviewed by the <br />Dwi ted UST O erator. Attach a co o the alarm Mato re ort/lo to this form if available. <br />4 Each alam far the vrevious month has bczn responded to a ro riatel . <br />5 Sensors located in tank-toE containment sum s da re stat aYatmed in the past month <br />5a List all tank-lop sumps where alarms occurred W the past month; -1�- <br />C.titoy-fi v - (wa £-4-- e*_4 r-tt�l tt•,rEa <br />Kota SwnPs wiasre an alarm has oecrwred in the part nwnA muff hr inapeeted weiass a gtwlt0,vd sarrlat 'a-Wv1— raspnrrdad to, and _—a► <br />properly addre tatcf the ca— of the alarm. Anach dacmmmartaa var6rying apprroprtam service to rhGr report <br />i er tton iq r uirad, record rastrlts to (terra 6, �tlow. G�t-q <br />UST SYSTEM INSPECTION <br />6 Tank-top cttail"Vanat sumps are free of water, debris, and hazardous substasmce. Sensors are located properly. <br />Neu: $1-d coon stars is awy hers aeaerrred in the p=i maurth err whieh dram is no sanies rssord <br />Y lY N <br />Y <br />Stem Locatlan; c'!�t-t f� Location_ <br />Srrrrt Lacalion Sum Location: <br />5�um Location: Smit Loca[fan; <br />7 Sill eamainment steuctures are tree of water doE�is and <br />Y 14 NA N NA <br />Y <br />Tank l -- Contents: Tank 3 — Comants: <br />Tank 2 Contents; Tank 4 — Contents; <br />8 Under-dis eaaser ooutainment areas are free of watsr debris, and hazardaua slibstanec.Sensors are Iocated ro erl . <br />Y N NA N NA <br />Y <br />A neer 9110 <br />,Dls eraser 3 / 4 Di laser 11 / 1 Z <br />fJis �trser 3 / G D ' er 13 / 14 <br />Dia eraser 7 / 8 Di nscr 15 / 16 <br />PAPERWORK IPiSP$CTION N NA DATE DONE <br />Y <br />9 Monitoring sipsts,.nj certification has been com feted witftin est i2 months. <br />10 Seton containment tests have been come leted within the re aired t� �� <br />i t S il! contaiitmetll structurt; !!tial tatin was tom farad within the est nal. <br />12 Tank ti fitness testiu cttm feted within irad timeframe. q 1 <br />l3 Line ti mess test#n was completed within r aired timne&amc, <br />' <br />l4 Other taped tes mnaiAtenanm was ootn Hated within r aired timeframe. t test/raainrience !tams below. <br />:.-- .1 WIfMaintetmance; te <br />Test/MaErttenance: <br />Page i of <br />November 2004 <br />