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BUSINESS PLAN &
INVENTORY PROGRAM
UNIFIED PROGRAM INSPECTION CHECKLIST
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FACILITY NAME: /-17 plee_5�OAJ
5l INSPECTION DATE:
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eV 64 9-3-TLI6
Section 2: Underground Storage Tank Program
❑ Routine )4 Combined ❑ Joint Agency ❑ Multi-Agency ❑ Complaint ❑ Re-Inspection
Type of Tank Number of Tanks 3
Type of Monitoring Type of Piping
OPERATION
C
V
COMMENTS
Proper tank data on file
X
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Proper owner / operator data on file
Permit fees current
Certification of Financial Responsibility
Monitoring record adequate and current
Maintenance records adequate and current
Failure to correct prior UST violations
Has there been an unauthorized release? ❑ Yes No
Section 3: Aboveground Storage Tank Program
Tank Size(s) Aggregate Capacity
Type of Tank Number of Tanks
OPERATION
Y
N
COMMENTS
SPCC available
SPCC on file with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?)
If yes, does tank have overfill / overspill protection?
C = Compliance V = Violation Y = Yes N = No
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Inspector: L-- iQAII 6 LIC—D) /-�
Questions regarding this inspection? Please call us at (661) 326-3979
White — Prevention Services Pink - Business Copy
FD 2156 (Rev. 03/08)