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UNDERGROV TANK PROGRAM OFFICIAL INS( r '-TION REPORT <br />I <br />,AN JOAOUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />-STOCK, CA 5205 <br />.4 <br />COUNTY NAME PHONETONNO. 468-93423 COUNTY T`"�J <br />SITE NAME: <br />h <br />INSPECTION DATE, <br />SITE ADDRESS:CITY/STATE/ZIP <br />Zo 6D X <br />/5 <br />-&X <br />CHANGES SITE/O R/PFRMIT'? YES <br />INO) TANK TANK <br />TANK T NK <br />CB SUBMITTED? __�:2 <br />FORM A AND/ORS <br />Qq�OMPUTER <br />COMPUTER 0 COMPUTER <br />NUMBER NUMBER <br />COMPUTER <br />NPMBER NUMBER <br />/ <br />TYP ePF INSPECT110 PUTER # <br />,V <br />7r <br />PER # PER # <br />E . R # PER # <br />CIP. <br />EXP. DATE EXP. DATE <br />DATE EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS ft <br />MAJOR <br />OR <br />MINOR <br />PERMIT TO OPERATE <br />'A <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />3 <br />P <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />k <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 _7 <br />—_� _–..__ _ <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSUR <br />l <br />oSulk <br />m w <br />Ct <br />:r <br />'� " <br />"I SIDUAL MATERIALS <br />REMO I <br />F�6 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS'AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK CNE) <br />FOLLOWS: <br />57 58F7 <br />59 <br />MAJOR MINOR NO <br />❑ <br />VIOL. VIOL. L_J VIOL <br />OFFICE: <br />INSPA <br />pIm <br />�aAlal­ <br />W <br />RECEIVED BY: <br />TITLE: <br />PHONE: <br />HECK: <br />AUT -3 CF I C. A -.\'A L5188 it <br />