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COUNTY NAME STOCKTON, GA 95205 <br /> PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS:. � � �f ! CITY/STATE/ZIP _ <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK p/ TANK OZ,--- TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> 1 PER# PER# PER# PER# <br /> C EXP.DATE'I. EXP.HATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK corrNrs rt � °, 55.-"�ts�' � <br /> MAJOR MINOR ?f�, k4r3i <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> i <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSUREL�S <br /> rn <br /> se7. `�� _ .fw _�,�•4Y�~�j SiZ�= _s;,, .;�,.,,�+'i;�.��a.u"'i� .` _�.$�'4ty-"o-s. �' a,;-F. . <br /> REMOVAL OF RESIDUAL 38 39 _ <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> TANI �," ;,*�.xWe- <br /> i - <br /> RMANENTu <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> I THE MARKED ITEMS REPRESE4T VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> NO <br /> OLOR ❑ VIOL R ❑ OL❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> HUT-3 ORIGINAL 5/B8 Of <br />