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1 <br /> fbwTY <br /> SITE NAME: <br /> SITE ADDRESS: r o CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# �y_pa.. PER# /O&v-03 PER# /CS>y-O y PER# <br /> /0p y EXP.DATE EXP.DATE EXP.DATE EXP,DATE <br /> TANK CONIENIS ii�.....m.,....®.,»v7. .„. v:_,s..... _.__.... :. . <br /> OPERATIONAL TANK MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 - - <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <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 <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 r.- <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSU r�a �, <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING""M B2 Sa.,npled cA, LuAc1 48 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 1AS J._.� <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: ZZTS ✓-2�oL-C4 47A CA c �,(�' <br /> QAC! e�c w ,4- gyp <br /> MAJOR 57 MINOR 58 NO -5ee etas <br /> VIOL. ❑ VIOL. ❑ VIOL. ItqyYn•G-t :� jy�i�(-prp /rt <br /> 59 {{� <br /> OFFICE: INSP: /1 Qvot d Z RECEIVED BY: <br /> TITLE: IRC PHONE: RECK: <br /> S,Ba <br /> NUT-3 ORIGINAL <br /> AIDSInfQrmnfinn 4raan2n _ <br />