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Permit z ~ Envlrom~ental Sensitivity Inspection Tine UNDERGROUND HAZARDOUS SUBST~kNCE STORAGE FACILITY * INSPECTION REPORT ?" . c-- oe I4FO No. of Tanks ~ la Information on Pereit/Applicat~on Correct? Yes -- No__ Per~/t Posted? Yes -- Type Gl Inspection: Routine ~ ' CoapIatnt Reinapectlon Consents: ITEM VIOLATIONS NOTED : Intercepting and Directing Syatee t ~ ~ ,~.~. .... 'd. In-Tank Level Sensing Device I :'~' ' e. Oroundwater Monitoring I , z' ' ' "'"~' : ..... ~ "' f. Vadose Zone ~onltorlng . / ~ ...."/,~. 1~ ,*~. f- C' ', ~,"i '~,~' "! L~ '~/ /~ (?/'~ 2.Secondary Containment Honltoring: a. Liner b. Double-Walled Ta~ c. Vault ressurlzed I b. Suction c. Gravity ........................................... J ............ :f .......................... ~; ..................... VI. Overfill Protection ,' -':'l /,'~ ~J~ "f'- -] "--' , ~1, ,f- ~- ' ~ ~'~ ~ (~,~ ~,t~,j: i,~ 5. tl~htne88 Tearing ..................................................................................................................................... 8. He~ Construction/Modification .............................................. 7. Closure/Abandonment ....................................................................................................................................... 8. Unauthorized Release - ....................................................................................... ................................................................................................................................... Co~ents/Reco~endattons: ' '" .... ~l --.'~' '~"~-'~' :- ~ '-~ ~: '~ "'" ' ' ' ' - '.--'-'-: '"'~ t: 'C/ ,~ ~L ~_ -~i c., //t~-L.t / ~'~ .~.~ ,,- !~./~/ ~ . . i Relnspectlon scheduled? Yes No Approximate Relnspeotlon Date -- INSPECTOR: REPORT RECEIVED (Form $H/~P-170)