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UST PROGRAM INSPECTION REPORT <br />Facility Name: Address: <br />25 CCR 2643 (d) <br />26 CCR 2643 (e) <br />27 <br />CCR <br />2662 <br />28 <br />CCR <br />2661 <br />29 <br />HSC <br />25286 (a) <br />30 <br />HSC <br />25298 (a) <br />31 <br />HSC <br />25298 (b) <br />32 <br />HSC <br />25298 (c) <br />33 <br />Observation(s): <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 />IMMUN, QW, <br />Ina <br />,► <br />k �. i`. 7oc. <br />Inspection: Type ( �v�, Date \Az) t.�Q \ <br />REHS Print <br />— <br />Receive Print <br />Title Phone <br />PHS 260 (8/04/00) 2 of <br />