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G >IyA OFFICIAL INC ON REPORT <br /> A�yK pRQ HEALTH DISTRI <br /> O� �Q ("'F HAZELTON AVE. COUNTY # <br /> G`R STOCKA <br /> PHONE TNO. 468ON CA -3423 <br /> INSPECTION DATE: _5'-J�--!67 <br /> CITY/STATE/ZIP CSI <br /> t011 TANK TANK TANK <br /> LRMIT? YES NO TANK COMPUTER COMPUTER COMPUTER <br /> gyp. COMPUTER NUMBER NUMBER <br /> S1�� �ciMITTED. NUMBER y� NUMBER <br /> 4R�S SITE COMPUTER# I I PER# ' PER# <br /> PER 7- PER# /7S# <br /> SIDE EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS <br /> G 6NAL TANK MaJOR MINOR <br /> MIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 <br /> APPROVED MONITORING SYSTEM 9 1Q <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> li <br /> MONITORING RECORDS MAINTAINED 15 16p <br /> ACCESS CASING SECURED 17 18 <br /> 19 20 <br /> PIPING <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 49 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> 48 <br /> PIPING 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> c <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> r c <br /> 5758 <br /> 59 <br /> MAJOR F-1MINOR � NO — <br /> VIOL VIOL. VIOL, <br /> OFFICE: <br /> INSP: C i t�r CZ RECEIVED BY: <br /> TITLE: <br /> PHONE: BECK— <br /> HUT-3 ORIGINAL <br />