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UNDERGROU&TANK PROGRAM OFFICIAL INSPjTION REPORT <br /> SAN JOAQUIN HEALTH DISTRICTW <br /> 1601 E. HAZELTON AVE. <br /> CA 5205 <br /> COUNTY NAME S6*4 -�o¢ PHONETNO. 468-93423 ff;; COUNTY #3 9 <br /> SITE NAME: ' ClOwl--LT/C�INSPECTION DATE: -3- / <br /> SITE ADDRESS: -7 , CITY/STATE/ZIPS yYi? )/ �t5��o f <br /> TANK <br /> ORM A AND/OR B SUBMITTED?CHANGES <br /> YE NO COMPUTER COMPUTER COMPUTETANK 0 TANK 0 TANK R COMPUTER, <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK ri <br /> NTENTS <br /> MINOR <br /> PERMIT TO OPERATE 2 <br /> CHANGE IN CONDMONS TO OPERATE 4 <br /> APPROVED CONSTRUCTION 6 7 <br /> WRITTEN MONITORING PROCEDURES 8 <br /> APPROVED MONITORING SYSTEM 10 <br /> MONITORING SYSTEM 12 <br /> APPROVED MONITOR FREQUENCY 14 <br /> MONITORING RECORDS MAINTAINED 15 116 <br /> ACCESS CASING SECURED 17 118 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 136 1 <br /> CONDITIONS ABATED 37 <br /> 4 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 139 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED ME 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 _ <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 <br /> IMPROPER ABANDONMENT 55V 56• <br /> THE MARKED II-T+E�MS,REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: / Q <br /> MAJOR 57 MINOR 8 NO 59 <br /> VIOL VIOL ❑ VIOL❑ <br /> OFFICE: INSP: <br /> 5✓1ICdG�'G� O -C? <br /> 5 <br /> ' ` v � nj /1C <br /> TITLE: RCrS/7 S PHONE: ( L - / / �'/7 y,J -No(b <br /> HUT-3 ORIGINAL Jr�C,G [ siae/©• <br />