HomeMy WebLinkAboutINSPECTIONS UNDERGROUND INJECTION CONTROL PROGRAM
INSPECTION REPORT
Inspector ~r~
Facility Info~ation
Facility Name ~~ ~k;~ d~om Phone ~o.g~
Parent Company
Address ~/~ 2~~& J~
City State e~ Zip
Contact Name and Position ~/~ ~R~%
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Description of waste stre~
Descrip.t, ion of injection well
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Description of activity that may endanger ground water but not
related to injection wells or tanks (e.g. ponds, spills)
Inspection Information
Inspection Date ~
Number of Wells
Well Type Auto Service ~ Industrial Waste
Agricultural Drainage StOrm Water Other
Status of Wells Active Abandoned Under Construction
Other ~
Inj ectate Sampled(Y/N)
Violation Found(Y/N)
Follow-Up Needed(Y/N)
RCRA Facility(Y/N)