The URL can be used to link to this page

Home My WebLink About2013 REPORT FMCUNIFIED PROGRAM INSPECTION CHECKLIST Underground Storage Tank Program M =w BAKERSFIELD FIRE DEPARTMENT Prevention Services Division 2101 H Street Bakersfield, CA 93301 Phone: 661 - 326 -3979 Fax: 661 -852 -2171 Facility Name: C Date of Inspection: j / r/ .� / Time In: 6ql�v Time Out: .° 0 -Mobil Address: 13001 Stock ale Hwy. Bakersfield, CA. 93312 Inspected by: Esther Duran ICC# 5296325 -UI Contact: Foni Chao T e of Inspection: Annual Compliance ❑Re- inspection ❑ Complaint Phone: 661 -79$6 Permission for Insp ction Granted by: Tank ID #1 # #3 #4 Size 10,000 10 000 107000 1 `0, 000 Contents REG PREM DSL REG Construction DWF DWF DWF DWF Tank Monitoring: DW: Continuous Interstitial Monitoring 5K5_ ry ❑ Brine/Hydrostatic ❑ Vacuum /Pressure. SW: SIR and Line Test every 2 years. ❑ ❑ ❑ ❑ SW: ATG 0.1 annual. ❑ ❑ ❑ ❑ SW: ATG 0.2 monthly. ❑ ❑ ❑ ❑ SW: Continuous In -Tank Leak Detection (CITLD). ❑ ❑ ❑ ❑ SW: Tank Gauging. ❑ ❑ ❑ SW: Vadose /GW Monitoring. ❑ ❑ ❑ ❑ Other Description: ❑ ❑ ❑ ❑ Piping Monitoring: DW Suction: Continuous Interstitial at UDC and Tank Sump. ❑ ❑ ❑ ❑ DW Pressurized: Interstitial at UDC and Turbine Sump and 3.0 gph LLD, ❑ Annual Line Test or Auto - shutdown and Failsafe. �- DW VPH Monitoring: Includes lines, sumps, fill pipe, vapor lines, etc. ❑ ❑ ❑ ❑ SW Conventional Suction: Triennial 0.1 gph line test., and daily monitoring. ❑ El ❑ ❑ SW Pressurized: Line 0.1 gph annual or 0.2 gph monthly line test and LLD with Auto - Shutdown. ❑ El ❑ ❑ SW or DW Safe Suction. ❑ ❑ ❑ ❑ SW: Vadose Zone or GW Monitoring. ❑ ❑ ❑ ❑ DW or SW: Gravity Flow Pipe. ❑ ❑ ❑ ❑ Other Description: ❑ ❑ ❑ Code of Regulations and the Code of Federal Regulations throughout this Appendix are intended to be useful but are not necessarily exhaustive of all legal references that might apply or be relevant to a specific compliance determination. Laws and regulations are subject to change, so the references contained herein may not be up to date. It is the responsibility of the owner and operator to know and comply with all applicable legal requirements. UNDERGROUND STORAGE TANK COMPLIANCE INSPECTION REPORT Facility Name: Date: Bakersfield Fire Department — Prevention Services Division, 2101 H Street, Bakersfield, CA 93301 (661) 326 -3979 If in compliance, check the box. Check NA if not applicable. If a violation, determine if Minor, Class II, or Class I, or To Violations Be Determined (TBD) if uncertain and will be determined later. eptgy .j,".,,:. i,. ". .." .'�'�`•'m ..,<,...�� .'.r±�^"� ..... .}, ;ke: .r.: �a.'.S'':`^ym�� 'F.l�..�*' w"p;�; 2.""";f :,3 �'""''ir`, -:: �' M:6:',:'"'"� �*- u�F.� { i � .;� _ �'i; a„ . �%.. .-v 'r; �'i:.?.?, t . •. ' ., f�'� _�.� ...Sxi s...•5". .. .,, y,. rv...n"�k, � ....tY:.:: ..4r,. w r: .m. �e�+ - #R e .,, .. -;we r".�fii3' `"`y v.,1•k... »�5... ... a?. _. .S .i� .�. .. . ,.. �, . ..... '. .. .. .. e , � r. ,� - „ gig.. � , .:.. «'... �, _,eA'-.n.� �.c�aa. ?.. � ., .* ..:...:, *f .. r . .�, . _ a��✓,.. it �7- {r: s .i.� -: �.� � ar. ��k :; «, __. _ .,, b• .• .J.,.FL. _ .:� _ - i ',(-. ...r, f ...L`Nr - `,a'1''�k. ... ;F:: ➢.fir: g+it. z�' 't,. _ i Y.. r .. �' .'. ., _ :' ,, t .,Y z. '., , :..a,.. ",..) ��'.Q R. ..::. y ,fit �, i_ :. r . n. 6 . ��.z_e?, 2.*�: ,�'»�, �� r n,... an. -..,�. .,. - ., '�. :�,... �,. -t `�'=tn',. F .,.... 4 -:. 4,}7 �:.,: R; ,?,. 2.: ,,. ,�'S ;.. A, .� ' x,> : .. _. - �� .. -.i,: h 45�� L'+ZS�;:a �,�'. H✓ ,�"'� y, ~ :. �"� h rk`3 G :. ��) �-." !'v .i.'k.,k, ._,.. -.: ±...,: Fx .._ ., •>�Ci � „ .i�+e?k 'il. m k' �r >? _.�� %.y'�:. ...... ,-'!. %xu.. � ++ .. ,a!,.:. � _r . , � „� k6::... `m. , Ka§'. �� s r.., sf ,, Ei- a�4. ... . "''.et... ? .. �� r .:n, y.. r -as ...�« r,,i .,x.,r, a4-z ,. ;::. f{' �su+ ..:+r:\ r..: rcru '. .. Cwt. -.. ,. �a xr' cam:., .p,�'"..> �. , .;. -. K :'l, s -_: .. .Cr1A> ��-' � � ,t .. )-. v<.a ,.; �,. ,. � .4 ,:, ::?v "`Ys , s�'.,t '� _ %. - ��';'1 ..., . �5 ""*�F i Y ., 9... �'a}r.,. -'.3'. 'fix. ..��,. a�. �. '� ��': ��`.�,.. .*�.se•. w., �i � s+...� �1 • °:�d� $;, �t� : -� _�... ��?'.,5 °i: zs H u.. -. ''. x �. •i"... R : + �.; x+,- •s'..S W ,. r:r b �s .er�,� � 4 f�.,,� 7,4' pzu "r`� 'R:«'s•23'i t�Jy kii - $� s ��1 ; "i� �4:.�F,� ., n) t. __•'y��A.?�.',�✓ � IRiY^^ - 7�`3.. �� c Aa p.^.^Y � _.J qE �§ :. r ,... ... .... a H .. .., a$ , m�'. .:a -. K $�r% i..,., Eo. uyv 5S „"J,ih.. ,.b TAI : .. -wY ✓? T.Y �>l /,�. .n iv. N+ .,?fi. t, r.. )'. +a,h- e .J'AS.. -..)t 3. ✓ „„... ,.. �i .�iS?: �y...,.r ... +ksa.Y »:. t�.S.. .. ..11 fi` k'. ..`:�'y`J � "31.+ :.� '�i3. n J�` J ),.. ..hf A'. i. �Y, ,�^..r f.:, a�Y 3t »:h , �j Y � A a'F '�:�`xV File Review ❑ 1 UST Permit to Operate is current. HSC 25284(a), 25299(x)(1) 25299 (b)(1) ❑ 1712 Transfer of permit and /or change of information provided within 30 days of ownership /information changes. HSC 25284(b) (c); T23 CCR 2712(d) 3 UST form information current/correct for facility, including BOE ❑ number. HSC 25286(x) 4 Fees are paid up -to -date. HSC 25285(c), 25287 ❑ )X5 Monitoring Plan approved for current owner with appropriate ❑ content and level of detail. T23 CCR 2632(d), 2634 (d), 2641(h) ;96 Current Emergency Response Plan submitted with appropriate ❑ content and level of detail. T23 CCR 2632(4), 2634 (d), 2641(h) )A�7 Plot Plan /Site Map submitted with appropriate content and ❑ level of detail. T23 CCR 2632(d), 2634(d), 2641(h), 2711(a)(8) ❑ 8 Owner /Operator agreement submitted, if required. HSC 25284(x)(3) ❑ 9 Certification of Compliance and Designated Operator ❑ Certification submitted by current tank owner. T23 CCR 2715 CuR+�' -"'a o -'' 10 Certificate of Financial Responsibility submitted and is current for the permit period. HSC 25292.2, 25299.30- 25299.34; T23 CCR 2711; 2808.1; ❑ 2809- 2809.2 11 Monitoring system certification (most recent) conducted within allowable timeframe (sensors and console). Results submitted ❑ and show all required components with passing results. Hsc 25284.1 a 4 (p); T23 CCR 2638 >412 Spill- bucket test results (most recent) conducted within allowable time frame. Results submitted and indicate a passing ❑ test. HSC 25284.2 13 Leak Detector testing conducted within allowable time frame. The most recent annual certification submitted and shows RD RD RD RD ❑ passing results. 40 CFR 280.40(a)(2), 280.43(8)(1) &(2), 280.44(a); HSC 25292(e); T23 CCR 2638, 2641 '914 Secondary containment testing conducted within allowable time frame. Most recent testing results submitted and indicate ❑ a passing test. HSC 25284.1(a)(4)(8); T23 CCR 2637(x) ❑15 Pipe and /or tank integrity testing conducted within allowable time frame. Most recent testing results submitted and indicate passing results. 40 CFR 280.33, 280.40, 280.41, 280.44; T23 CCR 2636(f), 2643b3,c3,(d ) (e ❑16 Repaired tanks /piping are tightness tested within 30 days of RD RD RD RD the repair. 40 CFR 280.33; T23 CCR 2661 017 ELD test conducted within allowable time frame. Most recent test results submitted and passing results achieved. T23 CCR 2644.1 ❑18 The corrosion protection system is checked by a corrosion specialist within six months of installation /repair and at least every three years thereafter; results show protection to be RP RP RP RP adequate. Impressed current inspected every 60- calendar days. 40 CFR 280.31, 280.70; T23 CCR 2635(a)(2) ❑19 Tank Lining recertification is current (within 10 years of lining and every 5 years thereafter) and compliant. 40 CFR280.21(b)(1)(Yj; RP RP RP RP T23 CCR 2663(h) Bakersfield Fire Department — Prevention Services Division, 2101 H Street, Bakersfield, CA 93301 (661) 326 -3979 Facility Name: UNDERGROUND STORAGE TANK COMPLIANCE INSPECTION REPORT Date: Bakersfield Fire Department — Prevention Services Division, 2101 H Street, Bakersfield, CA 93301 (661) 326-3979 On -Site '.Re Aim This Inspection is being con ,dec'ted during the annual monitoring certification S L7 NO The service technicia provided /CC Certification and -17 8,37 5-) if manufacturers training documentation, and possesses a tank tester's license or works under a CSLB contractor's license. L7 YES L7 NO a. Genera .:', Tank systems meet current construction standards as required F-1 fort e of system. HSC 25288 Hazardous substance tanks have secondary containment. 40 RP RP RP RIP ❑ CFR 280,42(b); T23 CCR 2631 ❑22 Electronic monitoring system has audible and visual alarm in ❑ opera ing condition. T23 CCR 2632, 2634, 2636 Monitor console programmed appropriately for monitoring ❑ option used. T23 CCR 2638, 2643, 2643.1 ❑24 Tank systems in temporary closure meet requirements. 40 CFR RD RD RD RD ❑ 280.70, T23 CCR 2670 & 2671 ❑25 Overfill Prevention mechanism present and operational according to type: ❑FIapper valve ❑ Audible-visual alarm RP RP RP RP ❑ ❑ball float. ❑ A/V alarm and Ball Float 40 CFR 280.20(c)(1)(Y), 280.21(d); T23 CCR 2635(b)(2), 2631(d) (4) V6 Spill prevention device is present and functional (in good condition and drain mechanism operational if applicable). 40 CFR RP RP RP RP ❑ 280.20(c)(1)(1), 280.21(d); T23 CCR 2635(b)(1);2665 ❑27 Piping and piping penetration boots within sumps/UDC are in ❑ good condition. HSC 25288(a), 25292.1 All sumps, spill buckets, and UDCs free from debris and liquid. ❑ HSC 25291(e), 25290.1, 25290.2, T23 CCR 2635(b)(1)(C) ❑29 Areas around vents appear to be free from signs of liquid ❑ releases. HSC 25288(a), 25290.1, 25290.2, 25295.5 Release Detection methods are present and meet performance RD RD RD RD ❑ standards. See LG-1 13. 40 CFR 280.40(a)(3) r-Al All sensors are correct for the type of system and operational. RD RD RD RD ❑ 40 CFR 280.40(a)(2), 280.43(g)(1)&(2); HSC 25290.1(e), 25290.2, 25291; T23 CCR 2638 A-2 E 2 All sensors are located in the proper position/location. 40 CFR 280.40(a)(2), 280.43(g)(1)&(2); HSC 25290.1, 25290.2, 25291; T23 CCR 2630(d); RD RD RD RD ❑ 2632(c);2641(a) All secondary containment, including UDC shall be equipped with a continuous monitoring system that either activates an ❑ A/V alarm or stops the flow of product at the dispenser when it detects a leak. 7yxz��cR2636 (op)�� Tzink, onhoring,-- INK M�Z ❑34 ❑ Interstitial monitoring conducted properly. 40 CFR 280.40(a)(2), RD RD RD RD ❑ 280.43(g)(1)&(2); T23 CCR 2632 (c)(2); 2634(d)(1) I 1 1 ❑35 ❑ VPH monitoring conducted properly. HSC 25290.1 RD RD RD RD 0 SIR ❑36 SIR and Biennial 0.1 gph tank test performed properly. 40 CFR 280.41, 280.43; T23 CCR 2643, 2646.1 RD 1 RD RD 1 RD ❑37 Non-passing SIR monitoring report results are reported and RD RD RD RD I investigated properly. 40 CFR 280.41(a), 280.43(h)(1),(2); T23 CCR 2646.1 _J111 I Bakersfield Fire Department — Prevention Services Division, 2101 H Street, Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANK COMPLIANCE INSPECTION REPORT Facilitv Name: natw O Automatic Tank Gauging (ATG) / Continuous In -Tank Leak Detection CITLD 038 ATG or CITLD 0.2 gph monthly test performed properly. 40 CFR RD RD RD RD 280.43; T23 CCR 2643(b)(1), 2643(b)(5) ,%39 ATG generates a hard copy printout of all data reported including time and date, tank I.D., fuel depth, water depth, temperature, liquid volume and duration of test. If installed after ❑ 1/1/95 printout includes calculated leak rate and leak threshold. T23 CCR 2643(b)(1) O Manual Tank Gauging (SW tanks </ =1000 gal. ONLY) 040 Weekly manual tank gauging performed properly. 40 CFR 280.43; RD RD RD RD , T23 CCR 2645 041 Tank Integrity test performed, if necessary. 40 CFR 280.43; T23 CCR RD RD RD RD 2645 O Vadose Zone and/or Groundwater Monitoring 042 Monitoring system is installed and monitored properly. 40 CFR RD RD RD RD, 280 Al. 723 CCR 2647 48 O Line Integrity Testing 051 SW pressurized piping: annual 0.1 gph line integrity test or a monthly 0.2 gph line integrity test is performed properly. 40 CFR 280.41, 280.44; T23 CCR 2643(c )(2 , (3 052 1 SW conventional suction system: 0.1 gph line integrity test is performed every three years. 40 CFR 280.40,280.41; T23 CCR 2643(d) N-1111111111111 min OMMMI N Bakersfield Fire Department — Prevention Services Division, 2101 H Street, Bakersfield, CA 93301 (661) 326 -3979 *Tank Exemption 043 Tanks /piping meet tank exemption criteria, and weekly visual e monitoring records are kept up-do-date. HsC 25283.5 Pipe Monitorin O Continuous Monitoring System ❑44 DW piping (gravity, suction, pressure) in the turbine sump has continuous monitoring system that activates an audible and RD RD RD RD ❑ visual alarm or restricts or stops flow at dispenser. T23 CCR 2636 f 1 045 DW piping in the UDC is continuously monitored and method either shuts down the flow of product to the dispenser or ❑ activates an AN alarm. T23 CCR 2636(1)(1) O Line Integrity Testing for Pressurized Piping 046 An annual 0.1 gph line integrity test is performed properly. (Either third party or by Enhanced Line Leak Detection) T23 CCR RD RD RD RD ❑ 2636( 4) 047 In lieu of the annual tightness test for DW pressurized piping, the monitoring system for all product piping outside the I dispenser is fail -safe and shuts down the pump when a leak is RD RD RD RD ❑ detected and the monitoring system shuts down the pump or flow restriction occurs when a leak is detected in the UDC. T23 CCR 26360(5) * Line Leak Detectors (LLD) 048 LLD's installed, annually tested, and operational on DW pressurized piping that detects a 3.0 -gph leak, and restricts or RD RD RD RD ❑ shuts off flow of product. T23 CCR 26360(2) O DW Emergency Generator Tank 049 LLD activates AN alarm and monitoring system is checked RD RD RD RD daily. T23 CCR 26360(2) r_1 50 In lieu of LLD, continuous monitoring system of DW emergency generator tank activates AN alarm, system is checked daily, and loos are kept. T23 CCR 2636 (t)(6) O Line Integrity Testing 051 SW pressurized piping: annual 0.1 gph line integrity test or a monthly 0.2 gph line integrity test is performed properly. 40 CFR 280.41, 280.44; T23 CCR 2643(c )(2 , (3 052 1 SW conventional suction system: 0.1 gph line integrity test is performed every three years. 40 CFR 280.40,280.41; T23 CCR 2643(d) N-1111111111111 min OMMMI N Bakersfield Fire Department — Prevention Services Division, 2101 H Street, Bakersfield, CA 93301 (661) 326 -3979 UNDERGROUND STORAGE TANK COMPLIANCE INSPECTION REPORT Facility Name: Date: ❑53 SW conventional suction system: inspections conducted for M 111M presence of air in the pipeline. Daily monitoring records are kept. T23 CCR 2643(d) 054 SW gravity flow piping: biennial 0.1 gph integrity test or overfill tank integrity test is conducted within allowable time frames. T23 CCR 2643(p) O Safe Suction (SS) System 055 Piping meets the SS requirements. 40 CFR 280.41; T23 CCR 2636(x)(3) RD RD RD RD A -D O LLD for Pressurized Piping 056 LLD's installed, annually tested and operational on SW pressurized piping. Pump shuts down when a leak occurs and RD RD RD RD when the LLD fails or is disconnected. T23 CCR 2666 ❑57 LLD's installed, annually tested, and operational on SW emergency generator systems; LLD is connected to an AN alarm. 40 CFR 280.40(a)(2), 280.43(8)(1), (2), 280.44(a); T23 CCR 2666 Corrosion Protection 058 Metal Tanks and piping components have corrosion protection, RP RP RP RP or are isolated from the backfill. 40 CFR 280.20, 280.21 059 Corrosion protection equipment turned on, functioning properly and provides continuous protection. 40 CFR 280.31(a),(b)(1); T23 CCR RP RP RP RP 2635 ❑60 Cathodic protection system is tested within 6 months of DZ installation and then every 3 years. 40 CFR 280.31(a) & (b) (1); T23 CCR RP RP RP RP 2635 a 2 061 Impressed current systems checked every 60- calendar days RP RP RP RP and records are up-to-date. 40 CFR 280.31(c); T23 CCR 2635(a)(2) On -site Paperwork 1.362 Permit and conditions available on -site. Facility is operated ❑ according to permit and conditions. HSC 25293, 25299; T23 CCR 2712(;) Monitoring and response plans are on -site and are the ❑ approved version. T23 CCR 2712(i); 2632 ;2634; 2641 4 Site plan depicts current site conditions and has all required ❑ elements. T23 CCR 2632(4) All release detection records for monitoring method are available, up -to -date, and appropriate for leak detection RD RD RD RD ❑ method. 40 CFR 280.41, 280.45 6 All monitoring /testing records /documents are available for the required timeframe. (3 years, 6 Y2 years, five years, life of tank) T23 CCR ❑ 2712 67 Equipment maintenance records/logs available. T23 CCR 2712(b) ❑ S Alarm logs /tapes available and appropriate follow -up actions ❑ Occurred. T23 CCR 2712(b); 2632; 2634 9 Visual observation logs available, up -to -date, and appropriate ❑ IK follow up actions to problems occurred. T23 CCR 2712(b); 2642 0 Designated UST Operator monthly reports available and ❑ complete. T23 CCR 2715 �� -i 71 Employee training records available and training appropriate ❑� = and up-to-date. T23 CCR 2715 l 072 Suspected or actual unauthorized releases are recorded and /or reported within allowed timeframes, including non- RD RD RD RD ❑ passing test results. Leak and Spill Logs available. 40 CFR 280.50; T23 CCR, 2650, 2652 3 Financial Responsibility Certificate and mechanisms (CFO Letter, etc.) on -site and up -to -date. HSC 25292.2, 25299.30- 25299.34; T23 ❑ CCR 2711; T23 2808.1; 2809 - 2809.2 L L Bakersfield Fire Department — Prevention Services Division, 2101 H Street, Bakersfield, CA 93301 (661) 326 -3979 UNDERGROUND STORAGE TANK COMPLIANCE INSPECTION REPORT Facility Name: Date: On -Site Observation of Periodic Testis"_q ❑74 Spill-bucket testing conducted appropriately and a passing test achieved. ❑75 Secondary Containment testing conducted appropriately and a passing test achieved. SOC AND RED TAG U a. This facility is in compliance with Release Detection (RD) requirements only. (No violations in boxes marked RD, but one or more in boxes marked RP.) b. This facility is in compliance with Release Prevention (RP) requirements only. (No ❑ violations in boxes marked RP, but one or more in boxes marked RD.) c. This facility is in compliance with BOTH Release Detection (RD) and Release ❑ Prevention (RP) requirements. (No violations in boxes marked RD or RP.) d. This facility is NOT in compliance with both Release Detection (RD) and Release Prevention (RP) requirements. (One or more violations marked in (both) boxes RD ❑ and RP.) A Red Tag was issued to this facility based on the results of this inspection. Red Tag # Reason for Red Tag (Choose one): 1. Violation that causes or threatens to cause a liquid release. CCR 2717(a)(1) ❑ 2. Violation that impairs the ability of an UST system to detect a leak. CCR 2717(a)(2) ❑ 3. Chronic violation or committed by a recalcitrant violator. CCR 2717(a)(3) ❑ Item I # Inspection Comments: Bakersfield Fire Department — Prevention Services Division, 2101 H Street, Bakersfield, CA 93301 (661) 326-3979 POST INSPECTION `INSTRUCTIONS: • Correct the violations) .noted .above by Signature (that all violations have been corrected as rioted) ® Within '5 days of correcting a1,l of theviolations, sign and return :a copy of this page to: C' V C= Compliance ( ) OPERATION V= Violation COMMENTS r ❑ APPROPRIATE PERMIT ON HAND (BMC: 15.65.080) � + 0 ❑ : Business PLAN CONTACT. INFORMATION ACCURATE (CCR: 2729.1) VISIBLE ADDRESS (CFC: 505. 1, BMC: 15.52.020) ❑ . CORRECT.00CUPANCY (CBC: 401) (. ❑ VERIFICATION OF INVENTORY MATERIALS (CCR: 2729.3) ❑ VERIFICATION OF QUANTITIES (CCR: 2729.4) ❑ VERIFICATION OF LOCATION (CCR: 2729.2) ❑ PROPER SEGREGATION OF MATERIAL (CFC: 2704.1) 0 VERIFICATION OF MSDS AVAILABILITY (CCR: 2729.2(3)(b)) ❑ VERIFICATION OF HAZ MAT TRAINING (CCR: 2732) VERIFICATION OF ABATEMENT SUPPLIES & PROCEDURES (CCR: 2731(c)) .- ❑ EMERGENCY PROCEDURES ADEQUATE (CCR: ❑ CONTAINERS PROPERLY LABELED (CCR: 66262.34(f), CFC: 2703.5) ❑ HOUSEKEEPING (CFC: 304.11) FIRE PROTECTION (CFC: 903 & 906) SITE-DIAGRAM ADEQUATE '& ON HAND (CCR:; 2729.2) X Y HAZARDOUS WASTE ON SITE ? ❑ _YES ❑ 'NO Signature of Receipt.,. -�- r Explain: - POST INSPECTION `INSTRUCTIONS: • Correct the violations) .noted .above by Signature (that all violations have been corrected as rioted) ® Within '5 days of correcting a1,l of theviolations, sign and return :a copy of this page to: 4*1 Owner /Operator: FaciIi r There were NO violations observed during this inspection. x .... .,. .�.�' �^'. �, .., ,,. x...xrx�"�a. >. r, T ... R....... �.x! ..,, w. r• ::�..rE r m� �.�W n h_ - 'r „•... ,., t . .r':r • .... ,.... r.. '.. 3 ... ...... ;v...43...,. n a kr.. .. �'.Y ..- ...<..... .•'. N d,,. :??x.. ... MRS ,x.. '§�. �. �•. - .,. ,... ems. ... r ...... ..... ..... w ,... .� .. .� .., n. v .:� _.�„ r .. . � ;..� at �_"<.. si ``?. ,,, i1 -. a. , r.�,,,,,,.a . , .. 3.'y,�, ., ...� _.+# . ,.... ..., s .,. >„_., z..-2 r.�. ' .� .�a :,, �. _ •� ^r. _., t ,.a .F ,.r, ` .,r= .- .t`��u >.... .. .....: d'�"°.. .. #' .. .. a:. a+�..,... .,,.. � :�.'n• .. ,.`f .. Y �,a'.a,...• 1 'emu h*... •'r. FS...• re.�4” y.J. +£r .. .. r .., r,.. �� r � . 2. 'M$ 3v. i�G � vvrr, d 9 . � ... x.. r,. C<. a..,.. .. .,..r. N ..:, .. u+ :� .. ti•' ",.,t... E ... t I... '�' �'+h ft m.s. y- ' .,?4 -! .�. .,.,' "r.:. d� S ..:.� ,., > .. ..,� ,, r .., ..,. ,�r..:3. •�,.,. . rrmx fl�x,r ._. o- ... .1 .._. � ��t; ..,��. ,:� v� ,,:. .-,. .. r g,.:�§..., S ,.Ag �, ,�„r�''� eh,"".�.n.. tom:. '� � �. �` r, 3� ,.:.:, .. �{., �'%.. hr' r u. ?r�z ...raa?k§nx .. . ,. ... ,. �. ,,, ... ., ... ,�..�•,.�'.,�.�*a, .k <.. . F., ..., ., .., ,a �' h:.,. � ,. 5, YY, .. 3..... ".�',..� 3 :��nS a.,.,.� - .e kM1:. .,. .y3 w'� � ! � Y - �.n e. I �" ..u.•i! +V. "' ,.yS.F ..�TU'f - ��:eF.Y5'?'r�.. 2s�i h=1 .i?�.�e: w)k'YE•..^��?.' :mti.;� ,.a:�.2.... �:.trre�'�'.�fiY Ae� �`}Y,.E. ...W.,.r s..t".. '�, �.�. t.l3.t.:.�...aw� �i« .,�.. ,,kS,.ss�- .��'S4' `a.:a oz... ,.rat., x+ ...:.a Notice to Comply: Minor Violations were found during this inspection as noted in the following Summary of Violations. The violations indicated in this inspection report must be corrected within 30 days, unless otherwise noted. Formal enforcement may be initiated for any violations noted, and for those not corrected in a timely manner. This report. does not represent that there are no other violations at this facility. A re- inspection may occur to determine compliance status. SUMMARY OF VIOLATIONS r__1=RT11=1rtATI(')N ()F RFTl1RN TO COMPLIANCE certify that the violations noted above. on this Notice to Comply/Summary of .Violations have been corrected: I have personally examined any documentation attached to the certification to establish that the violations have been corrected. Signature: Title: Print Name: Date: KPS #8446 1A1k;4c _ D ;i . r'^mx, Valln \A! — Ri minacc (^nnv to ha cant in after Return- tn- Cnmnliance Pink — Prevention Services Coov