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17 <br />Facility Name: Address: <br />25 _CCR 2643 (d) <br />26 CCR 2643 (e) <br />27_X CCR 2662 <br />28 CCR 2661 <br />29 HSC 25286 (a) <br />30 HSC 25298 (a) <br />31 HSC 25298 (b) <br />32 HSC 25298 (c) <br />33 <br />(lti.nn.-i�n4inn�ei• <br />Triennial tightness test of suction piping that is not continuously <br />monitored <br />Biennial tightness test of gravity piping that is not continuously <br />monitored <br />Upgrade requirements for UST system <br />Permit to repair UST system <br />Permit to alter monitoring system <br />Illegal abandonment of UST system <br />Permit to temporarily close UST system <br />Permit to close UST system <br />Violation(s) not listed above <br />Inspection: .. Date, <br />y <br />R .. ,� N.` it Print 1 - / � <br />Title— Phone <br />1 <br />M <br />PHS 260 (8/04/00) . 2 of .T— <br />