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UNDERGROUND TANK PROGRAM OFFICIAL INSPECTION REPORT <br /> COUNTY NAME <br /> �. SITE NAME INSP DATE: <br /> SITE ADDRESS 5 C/S/L <br /> CHANGES ID N ID N <br /> S TE/OWNER/OYER 7 TANK TANK TANK TANK <br /> ID N <br /> I YES M.F.R. SUBMIT. ID M 5-4450 P <br /> PER N PER N PER N PER N <br /> IF SITE COMP. N TYPE OF INSP Exp DATE EXP DATE EXP DATE EXP DATE <br /> DPKRATIOMAI. YIOUITIONS <br /> 1. Permit to Operate <br /> 2. Change in Cond. to operate <br /> 3. Approved Construction <br /> 4, written Monitoring Procedures <br /> S. Approved Monitoring System <br /> b. Monitoring System Operational <br /> 7. Approved Monitoring Frequency <br /> B. Monitoring Records Maintained <br /> 9. Access Casing Secured \ <br /> 10. Piping <br /> It. Inventory Reconciliation <br /> 12. Tank Guaging <br /> 17. Approved Response Plan <br /> 14. Unauthorized Release occurrence <br /> 15. SwVling <br /> ( 16. Approved Tank Repairs <br /> 17. Unauthorized Releases Reported <br /> 18 Safety Hazard <br /> 19. Conditions Abated <br /> TEIQ'OR71RY CIDSU 2E <br /> 20. Removal of Residual Materials \ <br /> 21. Flannable Vapors Removed <br /> 22. Access Locations Sealed <br /> 23. Power Disconnected <br /> 24. Owner/Operator Monitoring <br /> PF7iVMa7fT CIDSURE <br /> 25. Removal of Residual Materials <br /> 26. Piping <br /> 27. Flammable Vapors Removed <br /> 28. Unauthorized Releeee <br /> 29 SmWi Ing <br /> 30. Inproper Abandonment <br /> The marked itoma represent violations end mat be corrected as follows. <br /> —' <br /> r M - <br /> ( OFFICE: INSP:L� RECE[ <br /> it l <br /> pt{OME TITLE: RECHECK: <br />