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RANDOM-SAMPLE-HEIR SUPPLEMENT `l_Z-I-aO <br />1. Permittaa~j,~p~L~1dA//~~1~__mJ 1y1~~ ~_____. 5. Days since Lnst State Complete Inspection (LSCI) _~~ r <br />2. Permit Number ____l~_^_~J __QJ1_._^_______________-__ 6. Block 25 Categories in NON-COMPLIANCE this RSI ~~ .- <br />7. Joint Inspection I__X_I Y/N <. Dace _ q_-~~_-_~Q _ 7. Total Violations this RSI _~__ , <br />.rr.~^...~~~.~~~~...~..u•~~~~~~~~~~~r.rr~~~~~~~~~~r,...~.rr.~~^~rr~~~~~~~~~.~~.~rr~~r,~~~~~r~~~..~rrw~..~~~~~~rr~~..~.~~.~~. r.........•. <br />8. List (only once) all violations: <br />1) where State enforcement was reQUired and taken during the LSCI; <br />2J.recorded in the LSCI report but the State failed to take enforcement; <br />~) observed during thi: RSI which clearly existed during the LSCI but the Stste failed to take enforcement: and; <br />4) e:iatinq during this RSI .[hick are not already listed under one of the categories above. <br />A B C D E F G R I J N. <br />SPECIFIC STATE BLOCK 25 ABATED STATE REASON IF SERIOUSNESS OSMRE <br />LAN / REGULATION YIOLATED CATEGORY IY/n) ACTION UNCITED CAUSE PEO IMPACT ACTION OPTIOVAL <br />,. -- /-- /tee/4•~/ ''S I_C T-TAT- C?=1~T--1-_ TT- _~T-T ~- ice?=-T-T_ =-1---T_=-=1 <br />2. -- /-- / hug. /~}.'~ <br /> <br /> <br />N <br />_~ <br />Z <br />a• _ /-_ /_ /_ /_ I,l I -_I I__1 I_-_I I__i I_I I_I <br />I____I I <br />_I I <br />-__I <br /> <br />5 <br />/ / / T <br />r <br />T <br />. __ <br />- - - /- <br /> <br />6 <br />/ / ~ ~ <br />. <br />-- -- /-- /-- ---- ~.. --- ---- <br /> <br />7. - /--- /--- /-- /_ <br /> kmnDlw: <br />8. /- /-- /-- /- -~ --- _ ~ . ~ ~ ~ - -- <br /> kd[rrPlf.^: <br /> <br />9. --- /---- /- ~T~_~~Tl <br />/--- /-- -- T~T~~T^T___ ..- ___ _ ~I~~ <br /> <br /> <br />10. --- /--- /~ <br />,-- /-- r <br /> <br />S1AIF ACTION $lAlf'$ DEASDI Ep! X01 [111X6 VIR Al ION [ASSES PPoSabllllr OE ItIPF[I OSrYY ACI ICM <br />I) F+~dd a ISCI, tdrl IAEIFR DISOSSION YIfN hE SIAIF) I) Peru! Drled FVFNI OC(URDFX(E DUHI Dr•un YtMir the Pend Are[ I) D•Inrrd tr Slne Aden <br />I > F1nir1 a ISCI, ul :ilr: 1) Nd . Vuldw 1) Uund Yrdln (uld u•f 1 1 Mur •r U•Iddl 1) xur •r tb.n I) !M nrnd <br />)) Crtrd Prur b LSCI. I > PnddH 11 SI•le Pdiq 7) Wdlrcul Yuru I) ldrh I) Arder•le ~ J > Ih-CO u+.rd <br />AI•tnnl Pnlu, I > Nd n[Idd o1n Slde Pnlru 1) OPruUr MryliDucr ]) Ou.r rrd ] > Cunln•ble • 1 Prnunll Ci1r0~ <br />1) Oc[rml use LSCI / > Wnul prn a Im d [Old in S) DthrY. Dugr Erlndf IrraU thr Peat Arg pbJ not Padn0 <br /> S) Veldm nl unpurl luuedl ,..._.__.___._ /) Xnr rr Auu 5 > A•d rd ..ny a Idur <br /> i) Pndne Jlwrl ..du gpued Pend ~ S) Auerdr OSNtE hn•dm <br /> ,) to ^mr tr nlr ~) Gu Jndlr <br /> B > Yulnl all Openbr b Grrr[t 01dr.[tiw Ir F•lumnf <br /> 9) Otln: 7) Nnr a Amr <br /> B) Ardrnlr <br /> <br />