Permit •
' • - M CHAN,I CAL •• .,..,..
, . 4.,., C W ' PERM '1T hk.. : , g I E'C9 Itty,.
COMMUNITY DEVELOPMENT DEPARTMENT ,
13,125 SW Mall Blvd.'Tigard, Oregon 97223.81993 (503).639 -4171 - _ ' pA'TE, .I SS. 0ED _ Cli 6 /16 /9
SITE ' ADDRESS, ... 09538 SW T I GARD • ST. • PARCEL. e „ �aG10,E:iL�A� --01 121
C t 1 I - - C .'- t - .1! . f , ? I AMEND. � I ' ' -P -
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BLOCf,_ ...,. LOT....,.....,_. v r • .,
_ CLASS" OF WORK. ..1 ALT', - . ' " FLOOR FURI'd...., e ' _ EVPP : COOLERS e -
TYPE OF ... - OS' : CO g.r� ' ' 'UN HEATERS. . ' , {,ENT` , F . - - f-INS. ..' ' '
'Y •
OCC?. X'ANCY i3Ri 1.. e'B1. 1 TCRI VENTS . W/O _f 1F�r L_ e • ' ' ' VEI�i-I SY STE:ME,o ' '
ES a ' - 1 , -1 O1l_E Rs /CO PREiSSO S ' ,HOODS . . _ ' ,, . ..
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.2 iiG I / _. / 3_1 HF _ . CO;' ML., INC li�le - -
MAX - INr NUT g' ' BTU . _ - • ..i 0 HP . . r ?EP,,AIR UN .1 •'. '
F I RE DAMPERS? '•N 3u7 HP. . . . c - WOJI)S t O V ES o .g,' ' ., '
GW• PRESSURE —= i'r ' _. �'0 HP .... . DLO, _DRYLR ;... ' • ...
NO., - U I _• -_- I- TS.-,
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FURN < 100K. BTU! - (= 10000 c m e 1 GAS OUTLETS. g 3 .
FU RN ) =100K BTU e1 ').,= 'i0lZ uZI cfine • • - Remarks e , Construct , 240 e•gft clean 1-:-m,, acd'' of - gas - ' - ser , vic e' I ines.= , - - 4 . , - -
-. ----- FEES H .- - .------ . -------,-
'DIMEI'1S'iOINIAL_' FABr ICATORS - type ' • amount by date 'recpt
953 17 R SW. 1D S . - _ 1-'IRF•1T t I'_•'CJu 1� 93•'•1 4Zi917 . -
y" PLCK- $ 6. E5 JLH Q16/03/93 93- E40904 •
'1 IGAR'J -U R • ' ' 5PCT 3 1,. 25 • ..TLH '06/013/93 93 4Q190zi ,
• . Pfron'e. 4$e .,503.L620"..-936 . - ' - . - - • '
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_0,Sc E•,.NE Or:EGON .
PORTLAND, .OR 9722:7.1' • - ' - -- -- - -..._
P e 1•4: e 25/1.7-00 45: - _ , - 3 32.'5121 ,TOTAL „
Reg, f.., ,5435IZr -, ' ,
_- REQUIRED ,INSPE'CTIONS
- Thi s pehuit is, Issued subject to the reguiatiiors contained it the Me,chani.ca1 Ins p- _
• Ho and Nuni-cip i Code, State `•f GY Specialty f; -odes and all other I l i sc. Iii s f eet ion , ,
applicable °id'vs: Ail Wel i�i11 tie dome in ace ord_nce with i= i0aI- Inspection -
1 appt'oveo plans'.:; • This `peroit wi1n- expire' if WI is not- s'lat'ted __ � ._...__— .R..___ --
',aithin 16O days of, issuance, or if 'ionic is suspended for Dore - �_
than 182i days,
;5"-:1 m', , ,.t-,ill :L'' - •_-.
i� J 1 f Il �a �_! P ' 'I • fj _ -� ----7.'
t/ . `> _ — —
'Issued i y e ___L_ tiJ - - — ' - ----- — - -- -
. , - ,,Call foie inspect ion - 639-4175
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.A/1Z - c� /35
urn , Page
fied Sewerage Agency
1 of 4
Source Control Services Department
400 E. Main, Suite 200
Hillsboro, Oregon 97123
(503) 693-4541
(503)6481874 FAX INDUSTRIAL WASTE DISCHARGE PERMIT
Duty to Comply
The permittee must comply with all conditions of this permit. Failure to comply with the requirements of this
permit may be grounds for administrative action or enforcement proceedings including civil or criminal
penalties, injunctive relief, and summary abatements.
1.1a Applicant Business Name Dimensional Fabricators Inc. Location Code (permit #): 111 -097 -1
1.1b Business or Industrial Park Name SIC Number: 3471
1.2 Address of Premises Discharging Wastewater USA Treatment Plant: Durham
Street 9538 SW Tigard St
C Tigard State OR Zip Code 97223
1.3 Assessor's Map and Tax Lot Number 251 -2BA 1000
1.4a Mailing Address (If different than above)
Street P.O. Bon 23247
City Tigard State OR Zip Code 97223
1.4b Billing Address
Street 9538 SW Tigard St.
City Tigard State OR Zip Code 97223
1.5 Persons to be Contacted About this Permit
Primary Business Official (Name) Michael Dunlop Title CEO Tel. 620 -9361
Alternate Business Official (Name) Gary OFyen Title Operations Mgr. Tel. /1
Billing Information Contact Person (Name) Title Tel.
Pretreatment System Contact Person (Name) Mike Doherty Title Paint lead Tel. t
1.6 Effective Date: 1 q 1 11 0, Expiration Date: January 5, 1994
Monitoring Status ® Non - Monitoring Status ❑
1.7 Authorization: The above -named applicant is authorized to discharge industrial wastewater to the public sanitary
sewer system in compliance with the Agency's appropriate Resolutions and Orders, and applicable provisions of
Federal and State law or regulation, and in accordance with discharge point(s), effluent limitations, monitoring
requirements and all other conditions set forth herein.
This permit is granted in accordance with the application filed in the office of the Unified Sewerage Agency Source
Control Services by the permittee, and in conformity with plans, specifications and data submitted to the Agency
by the permittee, as well as payment of the following fees and charges.
In no case shall this permit be transferred to another owner, partnership or corporation without prior written
notification to the Unified Sewerage Agency Source Control Services. In the event ownership of the permitted
industry changes, the owner of this permit shall provide a copy of the existing Industrial Waste Discharge Permit
to the new owner or operator.
1.8 Owner's Representative
Print Name Gary Owen Title Operations Manager
Signature Date (- i7_ 5 g-
1.9 Agency's R presentative
Print Name Steve Anderson Title Source Control Investigator
Signature Date G/ q
Revised 12/91 White - USA. Green - Industry, Yellow - City, Pink - Accounting. Goldenrod - WOL Form 1291 -16
Olccfraarje Limit:Mor a e..rie Sempi410 G eopirer entc
Any Industrial user subject to reporting requirements shall maintain records of all information resulting from any
monitoring activities (40 CFR 403.12 (o)). Such records shall be included for all samples:
o The date, exact place, method and time of sampling, and the name or names of all persons taking the samples.
o The dates the analyses were performed.
Who performed the analyses.
o The analytical methods/techniques used.
• The results of such analyses.
• Calibration log for pH and flow meters.
•
Any Industrial user subject to the reporting requirements established in this section is required to retain for a minimum
of 3 years any records of monitoring activities and results.
if pretreatment standard violations are not corrected within a reasonable period of time as determined by the Agency,
or agreed upon previously, or if there appears to be indications of repetition of the violations, a Notice of Civil Penalties
may be issued as described in Agency rules. The Agency may seek or assess the maximum civil or criminal penalties
of at least $1,000 per day per violation of pretreatment standards, and any applicable compliance schedule. Compli-
ance schedules may not extend the compliance date beyond any applicable federal deadlines.
:Xofica:
•
Total Toxic Organics (TTO) is the summation of all values greater than 0.01 mg/L for each of the toxic organics
specified in the Priority Pollutant List In the Pretreatment Rules and Regulations.
All metals analysis shall be for total metals, unless otherwise specified.
The Agency may reduce or increase the frequency of sampling based on the analytical results submitted. '
24 hour composite sample - A sample representative of daily discharge: Flow- proportioned, or; a minimum of 1 sample
per hour of equal volumes collected over a 24 hour period. Samples may be composited and preserved according to
40 CFR Part 136 and amendments. An ideal 24 ho'r composite sample volume shall be 4 liters.
A "Grab° sample is an individual sample collected In less than 15 minutes, without regard for flow or time.
The sampling shall be representative of daily operations:
o A minimum of four grab samples must be used for
-pH
- Cyanide
- Total phenols
- Oil and grease
- Sulfide
- Volatile organics
o 24 -hour flow- proportional composite sampling shall be used for all other constituents
• Sampling and analysis shall be performed in accordance with 40 CFR Part 136, and amendments.
Cyanide - Four discrete grab samples shall be collected over the operating day. The samples shall be collected from a
point after the Cyanide Destruct process, but prior to mixing with other processes or domestic wastestreams. Each
aliquot shall not be lass than 100 ml and shall be collected and composited into a larger container which has been
preserved with sodium hydroxide to insure sample Integrity.
pH - Provide a daily summary of the ph strip chart record, noting the excursions out of pH range greater than 15
minutes, and noting the pH at the peak of the spike (high or low).
Oil and Grease - Four discrete grab samples shall be collected over the operating day. The grab samples shall be
collected in glass containers fitted with a ground glass stopper and preserved in accordance with 40 CFR Part 136 and
amendments.
All samples shall be collected at the sampling location designated under the Sampling Site Location section of this
permit.
•
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Loin.-- Pa e
nified Sewerage Agency 2 of 4
Source Control Services Department
400 E. Main. Suite 200
Hllbboro.Oregon 91123
(603) 693.4541
(503) Dimensional Fabricators
Location Code (Permit #): 111 -097 -1
Fees
Permit Remit Fees to:
Connection
Additional Capacity
Miscellaneous
Total
Reporting Requirements
2.1 a The permittee is required to submit testing results of wastewater.sampling and appropriate meter readings to
Unified Sewerage Agency (on approved forms) no later than the 10th of the month following discharge.
Specific sampling criteria and specific items to be sampled are listed in the Sampling Requirements Section,
below and on back of Page 2.
2.1b The permittee is required to submit testing results of wastewater sampling on a semi - annual basis. Waste-
water is to be sampled during the months of June and December. Specific sampling criteria is identified in
Sampling Requirements Section. Flow meter and pH meter readings may still be required monthly. If
required, they are due at the Agency no later than the 10th of the month following testing (or discharge).
2.2 Report any significant changes (permanent or temporary) to the premises or operations that significantly
;b change the quality or volume of the wastewater discharge or deviates from the terms and conditions under
which this permit is granted.
2.3 If sampling performed by an Industrial User indicates permit violation, the user shall notify the Agency within
24 hours of becoming aware of the violation. The user shall also repeat the sampling and analysis and
submit the results of the repeat analysis to the Agency within 30 days after becoming aware of the violation.
Additional Reports
The following reports are also due prior to the dates specified. If no date specified, report request does not
apply.
2.4 Report on compliance (ROC) due within 90 days of start-up. This report is necessary to determine the
immediate start-up compliance status (40 CFR 403.12 (d)). Due no later than:
2.5 Solvent, Toxic, Organic Management Plan, (STOMP/TOMP) due by the following date:
This plan is due to assess the uses and disposal procedures relating to solvents and toxics used in the
industrial processes (a federal EPA requirement).
2.6 Accidental Spill Plan (SLUG CONTROL) the following report is due:
This plan is required to assess the emergency planning of the permittee in case of a chemical spill in their
facility. The report must address the steps the permittee will take to keep spilled or unused chemicals out of
the sanitary/storm sewers, either by intentional or accidental release (40 CFR 403.8 (f)).
2.7 Hazardous Waste Reporting: Whenever the EPA publishes new RCRA rules identifying additional hazard-
ous wastes, the permittee must notify the Agency, EPA RCRA Director, and Oregon State Hazardous
Waste Director if any of these wastes are discharged to the Agency's treatment system. The notification
must occur within 90_days of the effective date of the published regulation (a federal EPA requirement).
— /ma c—
ww r /Representative Signature Agency Signature
/
Revised 12/91 White - USA, Green - Industry, Yellow - City. Pink - Accounting. Goldenrod - WQL Form 1291 -17
i1
•
Olocharse %,Ineitetlenu ariz Saim?1ng L lc.,\Vremortte
Any industrial user subject to reporting requirements shall maintain records of all information resulting from any
monitoring activities (40 CFR 403.12 (0)). Such records shall be included for all samples:
• The date, exact place, method and time of sampling, and the name or names of all parsons taking the samples.
• The dates the analyses were performed.
• Who performed the analyses.
• The analytical methods/techniques used.
• The results of such analyses.
• Calibration log for pH and flow meters.
Any industrial user subject to the reporting requirements established in this section is required to retain for a minimum
of 3 years any records of monitoring activities and results.
If pretreatment standard violations are not corrected within a reasonable period of time as determined by the Agency,
or agreed upon previously, or if there appears to be indications of repetition of the violations, a Notice of Civil Penalties
may be issued as described in Agency rules. The Agency may seek or assess the maximum civil or criminal penalties
of at least $1,000 per day per violation of pretreatment standards, and any applicable compliance schedule. Compli-
ance schedules may not extend the compliance date beyond any applicable federal deadlines.
Total Toxic Organics (T1 is the summation of all values greater than 0.01 mg/I_ for each of the toxic organics
specified in the Priority Pollutant List in the Pretreatment Rules and Regulations.
All metals analysts shall be for total metals, unless otherwise specified.
The Agency may reduce or increase the frequency of sampling based on the analytical results submitted.
24 hour composite sample - A sample representative of daily discharge: Flow - proportioned, or; a minimum of 1 sample
per hour of equal volumes collected over a 24 hour period. Samples may be composited and preserved according to
40 CFR Part 136 and amendments. An ideal 24 hour composite sample volume shall be 4 liters.
A 'Grab" sample is an individual sample collected In less than 15 minutes, without regard for flow or time.
The sampling shall be representative of daily operations:
• A minimum of four grab samples must be used for
- pH
- Cyanide
- Total phenols
- Oil and grease
- Sulfide
- Volatile organics
• 24 -hour flow- proportional composite sampling shall be used for all other constituents
• Sampling and analysis shall be performed in accordance with 40 CFR Part 136, and amendments.
Cyanide - Four discrete grab samples shall be collected over the operating day. The samples shall be collected from a
point after the Cyanide Destruct process, but prior to mixing with other processes or domestic wastestreams. Each
aliquot shall not be less than 100 ml and shall be collected and composited into a larger container which has been
preserved with sodium hydroxide to insure sample integrity.
pl-I - Provide a daily summary of the ph strip chart record, noting the excursions out of pH range greater than 15
minutes, and noting the pH at the peak of the spike (high or low).
Oil and Grease - Four discrete grab samples shall be collected over the operating day. The grab samples shall be
collected in glass containers fitted with a ground glass stopper and preserved in accordance with 40 CFR Part 136 and
amendments.
All samples shall be collected at the sampling location designated under the Sampling Site Location section of this
permit.
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V Page
Unified Sewerage Agenc 3 of 4
• Source Control Services Department
400 E. Main. Suite 200
Hllbboro, Oregon 97123
(503) 693-4541 Dimensional Fabricators 111 -097 -1
(503) 648 -8874 FAX
Location Code (Permit #):
Discharge Limitations and Sampling Requirements
The following monitoring requirements shall apply to the wastewater discharge from the permitted facility: -
Parameter Storet Units' Daily Max. Monthly Avg. Sampling Freq. Type of Sample
pH Max 400 S.U. 10.0 Continuous Strip Chart
pH Min 401 S.U. 6.5 Continous Strip Chart
CN(T) 720 * 1.2 0.65 Biannual Grab
Cd(T) 1027 * 0.11 0.07 Biannual 24 hr. Comp. •
Cr(T) 1034 * 2.77 1.71 Biannual 24 hr. Comp. ..
Cu(T) 1042 * 3.38 2.07 Biannual 24 hr. Comp. .
Pb(T) 1051 * 0.69 0.43 Biannual 24 hr. Comp.
Ni(T) 1067 * 2.7 2.38 Biannual 24 hr. Comp.
Ag(T) 1077 * 0.43 0.24 Biannual 24 hr. Comp.
Zn(T) 1092 2.61 1.48 Biannual 24 hr. Comp. ••
Flow 50050 GPD 1388 925 Daily Meter Reading .
TTo 90001 * 2.13 - Covered by TOMP
"e Applicable Regulations: 60 CFR parts 603 and 433.17
•
Special Requirements:
1. All sampling and testing will be performed as per 40 CFR part 136.
2. Submit daily flow meter readings and pH summary on monthly self - monitoring
report (SMR).
3. Discharge of iron phosphate process tank will be allowed only upon prior
approval by the Agency.
'mg/L, unless otherwise specified
digia --
P
0 . 0 %,-)(.—
Ow. -r /Representative Signature Agency Signature
Revised 12/91 White - USA, Green - Industry, Yellow - City, Pink - Accounting. Goldenrod - WOL Form 1291 -18
l' ots,6 ?."i'
Any industrial user subject to reporting requirements shall maintain records of all information resulting from any
monitoring activities (40 CFR 403.12 (o)). Such records shall be included for all samples:
o The date, exact place, method and time of sampling, and the name or names of all persons taking the samples.
• The dates the analyses were performed.
o Who performed the analyses.
• The analytical methods /techniques used.
• The results of such analyses.
• Calibration log for pH and flow meters.
• Any i; dusiriel user subject: to t:ie reporting requirements established in this section is required to retain for a minimum
o' 3 ye rc any records a: mo;li:3 ing activities and; results.
if pretreatment standard vinlations are not corrected within a reasonable period of time as determined by :he Agency,
ur agreed upon previously, or if there appears to be indications of repetition of the violations, a notice of Civil Penalties
may be issued as described in Agency rules. The Agency may seek or assess the maximum civil or criminal penalties
Of at least X1,000 per day per Violation of pretreatment standards, and any applicable compliance schedule. Compli-
ance schedules may not extend the compliance data beyond any applicable federal deadlines.
Total Toxic Organics (71 is the summation of all values greater than 0.01 mg/L for each of the toxic organics
' speerii ed it the Priority Pu lji.ent List In the Pretreatment Rules and regulations.
•
All metals analysis shall be for total metals, unless oths wise specified.
he Agency may reduce or increase the frequency of sampling based on the analytical results submitted.
•
2 recur composite se :e - A sample repreesntative of daily discharge: Flow- proportIoned, or: a minimum of 1 sample
per hour of er. ;L! &.i vu!:': ees e :le:tc° over a 27. hour period. See-pies may be coif poeited seed preserved according to
40 CFR Part 133 and £mendmems. An ideal 24 hour composite sample volume shall be 4 liters.
A 'Grab" sample is an it dividuel sample collected In less than 15 minutes, without regard for flow or time.
The sampling shall be representative of daily operations:
. A minimum of four prat: samples must he used for •
•
- Cyanide
- Total phenols
•
•
- Oil and grease '
•
•
- Sulfide
- Volatile organics
• 24 -hour flow- proportional composite sampling shall be used for all other constituents
• Sampling and analysis shall be performed in accordance with 40 CFR Part 136, and amendments.
Cyanide - Four discrete grab samples shell be collected over the operating day. The samples shall be collected from a
point after the Cyanide Destruct process, but prior to mixing with other processes or domestic !astestreams. Each
aliquot shall not be less than 100 ml and shall be collected and composited into a larger container which has been
preserved with sodium hydroxide to insure sample integrity.
pH - Provide a daily summary of the ph strip chart record, noting the excursions out of pH range greater than 15
minutes, and noting the pH at the peak of the spike (high or low).
Oil and Grease - t=our discrete grab samples shall be collected over the operating day. The grab samples shall be
collected In glass containers fitted with a ground glass stopper and preserved in accordance with 40 CFR Part 136 and
amendments.
All samples shall be collected at the sampling location designated under the Sampling Site Location section of this
permit.
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u Page
Unified •
Unlfed Sewerage Agency 4 of 4
Source Control Services Department
• 400 E. Main, Suite 200
Hillsboro, Oregon 97123
(503) 693-4541
(503) 648-8874 FAX
Sample Site Location
Location of sample sites indicated in the drawing are the official Agency and industrial sample collection loca-
tions, including the cyanide sampling point, if required. All samples tested for permit constituents must be
obtained from these sites.
Business Name
Dimensional Fabricators 111 -097 -1
USA Permit # /Location Code
S .W. T i g4rd St.
Offices
PP I h ¢ Are4
6dinSas Sian 9Ptefpb.te
,umbier
s l
• jump Vqa if
pH coati() I
Eff Went /defer
•wner /Representative Signature Agency Signature
Revised 12/91 White - USA. Green • Industry. Yellow - City, Pink - Accounting. Goldenrod - WQL Form 1291 -19
•
•
f
Any industrial user subject to reporting requirements shall maintain records of all information resulting from any
monitoring activities (40 CFR 403.12 (o)). Such records shall be included for all samples:
• The date, exact place, method and time of sampling, and the name or names of all persons taking the samples.
• The dates the analyses were performed.
Who performed the analyses.
o
The analytical methods/techniques used.
.0 The results of such analyses.
• Calibration log for pH and flow meters.
Any Industrial user subject to the reporting requirements established in this section is required to retain for a minimum
of 3 years any records of monitoring activities and results:
if pretreatment standard violations are not corrected within -a reasonable period of time as determined by the Agency,
or agreed upon previously, or if there appears to be indications of repetition of the violations, a Notice of Civil Penalties
may be issued as described in Agency rules. The Agency may seek or assess the maximum civil or criminal penalties
of at least $1,000 per day per violation of pretreatment standards, and any applicable compliance schedule. Compli-
ance schedules may not extend the compliance date beyond any applicable federal deadlines.
Total T oeic Organics (i O) is the summation of all values greater than 0.01 mg/L for each of the toxic organics
specified in the Priority Pollutant List In the Pretreatment Rules and Regulations.
All metale a nalyels theil be' for total metals, unless otherwise specified.
Y he f,ge cy ,icy eclece or increase the frequency of sampling based on the analytical results submitted.
24 hour composite: sari !:,.: • A sample representative of daily discharge: . low-proportioneci, or; a minimum of 1 sample
per hour of aqua! volumes collected 'over a 24 hour period. Samples may be composites; and preserved according to
,
40 CF? ;'ert 156 and aree :„ v.er.tts. An Ideal 24 hour composite sample volume shall be 4 liters.
A `Crab" sample is an individual sample collected In less than 15 minutes, without regard for flow or lime.
•
The sampling shall b,e reprRenntattive of daily operations:
• A minimum of four grab samples must be used for
• pi
Cyanide
- c otal r ;emus
- Oil and ;areas^
- Sulfidee r .
- Volatile organics
• 24 -hour ;low - proportional composite sampling sh4l1.be used for all biher constituents
• Sampling and analysis shall be pirR3?mYd in accordance with 40 CF. ^, Part 136, and amendments.
•'
r —
Cyanide - f='our discrete crab samples shall bs roil cted over, the op•eratingiday. The samples shall be collected from a
point eftar the Clienicie Destruct process, but piior to ml::lu• -. ith other processes or domestic wastestreams. Each
aliquot shail not lt.dTags than IOU ml and shall be colleciediand enmposited into a larger container which has been
preserved wiith sodium hydro :tide to insure sample integrity.
•
pH - Provide a daily summary of the ph strip chart' record, noting the excursions out of pH range greater than 15
minutes, and noting the pH at the peak of the spike (high or low).
•
Oil and Grease - Four discrete grab samples shall be collected over the operating day. The grab samples shall be
collected in glass containers fitted with a ground glass stopper and preserved in accordance with 40 CFR Part 136 and
amendments.
•
All samples shall be collected ai the location designated under the Sampling Site Location section of this
permit.
•
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1 . . LOCATIOPJ:
•
DIMENSIONAL FABRICATORS INC
•
95313 S.w.TIGARD ST. • •
1 TIGARD , Oa., 9'4223 Ph. 620 9361
INSPECTION NOTICE M C ' 3 3 J
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection:
Footing Plbg. Underalab Mech. Rough -in Appr /Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post /Beam Struct. San. Sewer Framing -Bldg.
Post /Beam Mech. Rain Drain Insulation - Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: Time: AM PM
Address: 9S 3 / Permit #: 9 3 - / 3
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: YZ! Date:
/V APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.