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UNDERGROUND TANK GROGRAM OFFICIAL INSPECTION REPORT <br /> COUNTY NAME <br /> SITE NAME U51FIZ usGr� INSP DATE: <br /> SITE ADDRESS 3Ct =T Z, C/S/L <br /> CHANGES TE/OWNER/OBER ? TANK TANK TANK TANK <br /> YES NO' M.F.R. SUBMIT. iDr l ID N ID M ID 0 <br /> PER 0 PER # PER N PER I <br /> SITE COMP. 8 TYPE OF IIISP EYP DATE EXP DATE EXP DATE - EXP DATE <br /> OPERATIONAL VIOIATIlON <br /> 1. Permit to Operate <br /> 2. Change in Cond. to operate <br /> 3. Approved Construction <br /> 4. Written Monitoring Procedures -- <br /> 5. Approved Monitoring System — '-- <br /> 6. Monitoring System Operational - <br /> 7. Approved Monitoring Frequency <br /> S. Monitoring Records Maintained <br /> 9. Access Casing Secured <br /> 10. Piping yV(-T(09 <br /> 11. Inventory Reconciliation ? <br /> 12. Tank Guaging -- <br /> 13. Approved Response Plan <br /> 14. Unauthorized Release Occurrence <br /> 15. Sampling — <br /> 16. Approved Tank Repairs - <br /> 17. Unauthorized Rehman Reported <br /> 18 Safety Hazard — - <br /> 19. Conditions Abated <br /> TEMPORARY CDOSUM <br /> 20. Removal of Residual Materials <br /> 21. Flammable Vapors Removed <br /> 22. Access Locations Sealed <br /> 23. Power Disconnected <br /> 24. Amer/Operator Monitoring <br /> PERMIAMO]IT CLOSURE <br /> 25. Removal of Residual Materials <br /> 26. Piping <br /> 27. Flammable Vapors Removed <br /> 28. Unauthorized Release <br /> 29 Sampling <br /> 30. Improper Abandonment <br /> The marked Items represent violations and must be correct <br /> V � <br /> INSP: i RECEI kf <br /> PHONE // TiR <br />