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UNDERGROUP"n TANK PROGRAM OFFICIAL INSP' TION REPORT <br /> "SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE- _ <br /> CA 95205 <br /> COUNTY NAME PHONETNO. 468-3423 COUNTY # S' <br /> J Ou cs.r, <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: 7 7 S CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? fYES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUNUMBER �y' j NUMBER NUMBER NUMBER <br /> PER# !V3/ a/ PER# PER# PER# <br /> v 3 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK con_- / <br /> MAJOR MINOR 11 <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 _ <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <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 29 130 --- <br /> APPROVED TANK REPAIRS 31 132 <br /> UNAUTHORIZED RELEASES REPORTED 33 134 1 _ <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED M43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSUR <br /> REMOVAL OF RESIDUAL MATERIALS [55 <br /> 47 <br /> PIPING 49 _ <br /> FLAMMABLE VAPORS REMOVED <br /> UNAU ORIZED RELEASE 52 <br /> SAMPLiN 54 _ <br /> IMPROPER ABANDONMENT 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> Wth749SeeZ 1/4(2 z�� <br /> MAJOR i MINOR ❑� NO 59 LPO � .4 .-rka "p �yeo/ <br /> VIOL VIOL. VIOL. <br /> OFFICE: INSP: C�p`O/ OZ RECEIVED BY: <br /> TITLE: '51y PHONE: RECK: <br /> HUT-3 ORIGINAL sieA OM <br />