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UIk1CL UP SUNF'ACE NINiNG RE:CLAMATIOt: AND ENFORCEN£IiT <br />RANDOM SAMPLE ME:R SUPPLEMENT <br />1. Permitt•a-~r~v~ ___________-.. _ _ __-_-_ 5. Days since Last Siata Coapl•te Inspection (LSCI) <br />:. Paretic Nu^ber ~_~~~ ~ __-.,_~__-_,-___ _-___________ 6. Block 25 Cat•gor ias in NON-COMPLIANCE thin RSI ~ - <br />7. Joint Inspection ~1 <br />I_-~I Y/N 4. Date ~L -_~~__-- ~ ~ __ 7. Total Violations this RSI ~_ <br />8. List (only once) all violations: <br />11 where State enforcement was required and taken during the LSCI: <br />Z) recorded in the LSCI report but the State tailed to take •n[oreeunt: <br />31 observed during this RSI which clearly ezasted during the LSCI but the State tailed to take enforce^ent: and; <br /><) •sistinq during this RSI which are not already listed under one of the categories above. <br />A <br />SPECIFIC STATE <br />LAN / REGULATION V20LATED <br />3 <br />a <br />5 <br />6 <br />Wmrn <br />E F O R I J K <br />REASON IF SERIOUSNESS OSMRE <br />UNC:TED CAUSE PEO IMPACT ACTION OPTIONAL <br />~~T--- -I~-T-- -~_ T-T-~T~~T-T=-T--1-1 <br />-- /-_ ~- /- /-_ I--I I___I I ~-I I--I r----I I--r I-I I-I lyl I-I <br /> Inu ql w : <br /> <br /> <br /> konpoC <br /> <br /> <br />--- /- /- /- /- I-1 I-_I I-I I__-I --- -I <br /> <br /> <br />Intr rrlnr:~~ { ~~~ -- ---I <br />irttr rrlro' <br />e. -/--- /-- /--_ /_- I--I I---I I----I I--I I---I I-I I__I I-I 1-I I-I <br />iutrgt nt: _ <br />ins nt m: <br />s)EfF A;nox <br />I) Fu ti rl tr lSCI. ulrl <br />1) 4ntn o LSCI. wt tdrl <br />]) Ltr/ Pna a ISCI, <br />ANlnnl Pnl•q <br />1) Dtnrnl utu lSCI <br />51CIf•! ;.per tra bl {tire pin Anpy <br />laI1F1 olsn)ssiDN Nlx IxF su1Fl <br />1) Ntr t U~tlttm <br />I 1 frrebol Ir Sate Pdrq <br />7) Nrl nNrwr uor ibir Pnpu <br />1 1 Worry p.n n Im d t Gltnn <br />:) Vnlnm u1 napurl bnull <br />i) fitttrtr Jlnrr ulrr tArrret Prrut <br />1) fu unr Ir ntr <br />B) Yrrlnt ath Dlatlu Ir Ctrnd <br />9) Dtwr. <br /> (~ rMeJll!'er' H Ixx'1 <br />I ) Frrut Deirtt E7FNr DCCVPAFw:E Dttrr Artr~n Y~thrl IM /rral Arq <br />I > Urrntl btlra (rd~linl 1 ~ Na a 01ddt 1 > lur tr Norr <br />7 > Y+rtl rt~d Gt nrr I > Ldrq : > NarUr <br />/) DrgUu Myrgatr 1) Dtnrrrl 7 1 (mNrn111 <br />S) Olerr. Dma Frlnn IrntJ Ihr Pant Ant <br /> •-_..._"_--•-•--••- t) bu a Arnr <br /> • S) Ntvdr <br /> i) Gndndle <br /> D+tlr+ti nr a Ftiutr+ni <br /> I) xwr a A~ur <br />O:NAF ACild <br />I > /rlern/ U Sltle Atlm <br />I) Ipl ruin <br />1) Ix-(D nnN <br />/) hnnnlr IItrJ~ <br />ANlnrrt Pnlul <br />3) Awlr/ IrrnP a Iron <br />GixeE Onectnt <br />B C D <br />BLOCK ^5 ABATED STATE <br />CATEGORY (y/nl ACTION <br />~ Y_ r_~_r~ J._r__ _ r_. -_ •. <br />