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0 10 <br /> UNDERGROUND TANK PROGRAM OFFICIAL INSPECTION REPORT <br /> COUNTY NAME <br /> SITE NAME _C INSP DATE: <br /> SITE ADDRESS C/S/Z t5cg <br /> CHANGES SITE/OWNER/OYER 7 TANK TANK TANK TANK <br /> YES NO M.F.R. SUBMIT. ID N ID N.-) f ' ID r i; - /,� ID N <br /> SITE COMP. N TYPE OF INSP PER N PER N PER M PER N <br /> 16�r) O EXP DATE EXP DATE EXP DATE EXP DATE <br /> OPEAATIONAL VIOLATIONS - <br /> 1. Permit to Operate <br /> 2. Change in Cond. to Operate n 6 <br /> 3. Approved Construction ` - — <br /> 4. written Monitoring Procedure i <br /> 5. Approved Monitoring System K <br /> 6. Monitoring System Operational <br /> 7. Approved Monitoring Frequency tG <br /> B. Monitoring Records Maintained <br /> 9. Access Casing Secured <br /> 10. PipingL '/��{,(,IZ� <br /> 11. Inventory Reconciliation <br /> 12. Tank Guaging i <br /> 17. Approved Response Plan <br /> 14. Unauthorized Release Occurrence <br /> 15. Sampling <br /> ( 16. Approved Tank Repair@ <br /> 17. Unauthorized Release Reported <br /> 18 Safety Hazard <br /> 19. Conditions Abated , — <br /> Tf]['QURY CLOSURE <br /> 20. Removal of Residual Materials <br /> 21. Flammable Vapors Removed <br /> 22. Access Locations Sealed <br /> 23. Power Disconnected <br /> 24. Owner/Operator Monitoring <br /> PEHIVJVWT 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 corrected an follows: <br /> `�. <br /> OFFICE: INSP: RECE <br /> PHONE (C <br /> Ti RECHECK: <br /> CO&[T4CT- cr�l5 <br />