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4511 Pacific Avenue PR0231216 <br /> February 16, 2022 Program: UST <br /> PHOTO 1: Incorrect overfill revention date on DO ins ection re ort. <br /> eyignated LIST pr9"Ouinq <br /> peral:or orage <br /> Inspection <br /> ank <br /> rk—ikNnspecCE tion Ile <br /> port <br /> gsystem c=_rtification been co <br /> mpleted within t Yes No <br /> nerd been corn he Past NA bate last <br /> fa Pleted within the Performa <br /> Past 21912021 <br /> 6months? uipment inspection been completed 21912021 <br /> cent testin within <br /> ndary g been completed within the <br /> /I5g Past 21512019 <br /> klightness testing been completed within re 711112018 <br /> quired <br /> meS� <br /> e tightness testing been completed within the required <br /> aures? <br /> ;r Test/Maintenance: <br /> erTest/Maintenance: ® � <br /> der Test/Maintenance: Annual Training Date <br /> 51271202'1 <br /> FACILITY EMPLOYEE TRAINING Yes N� <br /> lave all individuals performing facility employee duties received the required facility x [] <br /> employee training within the past 12 months? <br /> 17.COMMENTS <br /> This section may be used to record comments or observations that are riot current compliance <br /> deficiencies. <br /> ST oP <br /> e <br /> rator in Section 3. <br /> bV the designated UPage 4 of 4 <br /> Lydia Baker, SR. REHS Page 1 of 1 <br />