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UNDERGROUND TANK-xOGRAM OFFICIAL INSPECMN REPORT <br />COUNTY NAME <br />\. SITE NAME A i-�ro <br />TANK <br />SITE ADDRESS <br />i <br />CHANGESSE/OWNER/OPER 7 <br />YES NO M.F.R. SUBMIT. <br />TANK <br />IDN <br />PER N <br />EXP DATE <br />SITE COMP._# <br />TYPE OF INSP <br />Urt <br />OFMTIONAL VIOLATIONS <br />1. Permit to Operate <br />2. Change in Cond. to Operate <br />3. Approved Construction <br />4. Written Monitoring Procedures <br />5. Approved Monitoring System <br />6. Monitoring System Operational <br />7. Approved Monitoring Frequency <br />8. Monitoring Records Maintained <br />9. Access Casing Secured <br />10. Piping f�lZ�Z�f7�fG�iC <br />11. Inventory Reconciliation <br />12. Tank Guaging <br />13. Approved Response Plan <br />14. Unauthorized Release Occurrence <br />15. Sampling <br />16. Approved Tank Repairs <br />17. Unauthorized Releases Reported <br />18 Safety Hazard <br />19. Conditions Abated <br />T129'ORARY CIAOSOM <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 />PLFSWU*Nr 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 />-- <br />- <br />c� <br />C/S/Z L <br />TANK <br />I F -R 0 <br />EXP DATE <br />INSP DATE : c,- i <br />Themarked Items represent viola Ions and a fol ow <br />G f <br />OFFICE: <br />INSP: RECEI <br />i <br />NONE T I TLE: <br />iV D a u!� <br />TANK <br />TANK <br />ID NID <br />M <br />PER M <br />PER I <br />EXP DATE <br />_ EXP DATE <br />HE <br />