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UNDERGROUKD TANK PROGRAM OFFICIAL INSPECTION REPORT <br /> / COUNTY NAME <br /> SITE NAMEf INSP DATE: %�� <br /> VIR0MEhTAL HEALTH <br /> SITE ADDRESS p �� ���� C/S/Z <-)7 ICES <br /> tel/ <br /> CHANGES SITE/OMINER/OPER ? TANK TANK TAMC t TANK <br /> YES NO M.F.R. SUBMIT. ID r 7 ID r ID M ID r Ib <br /> PER r PER r PER r PER r ,� <br /> SITE OF INSP EXP DATE F. P DATE EXP DATE EXP DATE <br /> _ �-A-tZ <br />' OEI ATIOKAL VIOLATIONS <br /> i <br /> I. Persalt to Operate <br /> t <br /> 2. Change in Cond. to Operate <br /> 3. Approved Construction <br /> a. Mrlttar. !Sc;itc.-!ng Procedurec <br /> S. 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 <br /> 11. Inventory Reconciliation .� <br /> 12. Tank Guaging <br /> 13. Approved Response Pian <br /> 14. Unauthorized Release Occurrence <br /> 15. Sampling <br /> C16. Approved Tank repairs <br /> 17. Unauthorized Releases Reported <br /> 18 Safety Hazard <br /> 19. Conditions Abated <br /> T EPWOFiARY CU)SO 2E <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 /> 2S, Atmi val of Residual Materials 11111111111 ,11711111111 1171111111 <br /> 26. Piping <br /> 27. Flammable Vapors Removed <br /> 28. Unauthorized Release <br /> 29 Sampling <br /> 30. lmproper Abandonment <br /> itie warked Reins represent vlolatioWis and must be corrected as follows: <br /> 1. <br /> (Wt'ICE: INSP: a RECEI VED BY: <br /> PHONE d TITLE: RECHE-�PKc <br />