MO-3845_10618_CA_FNTR_20151110

North Carolina Department of Environment and Natural Resources
Division of Waste Management
UST Section, Corrective Action Branch (CAB)
INSPECTION REPORT
Date: %%' a'%f✓ RISK: fjf Inspector: /2
Name:
nty: �'J1vGL�
ion: ,4-jjAV
Information:
Incident Number:
UST Number:
GPS Coordinates:
Site Information Checklist
T
Operating facility? Yes No
Valid UST permit? Yes No
Number of tanks: Yes No
Site map/Well map verified (if no, explain discrepancies in comments section)? Yes No
Any visible spills/leaks (if yes, explain in comments section)? Yes No
Any visible water supply wells? Yes No if yes, distance to closest (ft.)?
n System(s) Information:
System 9
Fully installed? Yes No
Operating? Yes No
Free product present (verified)? Yes No
RP/consultantlother on site?
Name of RP:
Name of consultant:
Name of Other:
res Taken?
Location of photos:
spent on site (hrs):
r.
OU�S�
Yes No
Yes No
System 2 System 3
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Company:
Company:
Company:
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This inspection sheet is to be placed in corresponding Incident file upon completion