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UNDERGROI "'D TANK PROGRAM OFFICIAL INS'- -CTION REPORT v SAN JOAQUIN HEAQLNTH DISTRIG, 1601 E.5205 COUNTY NAME PHONETNO 46893423 COUNTY # NAME: INSPECTION DATE: SITE SITE ADDRESS: ��s ��v -- CITY/STATE/ZIP �Z CHANGES SITE/OWNER/PERMIT? YES NO TANK n� TANK TANK NK TANK A FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER # PER # PER # PER # PER # EXP. DATE EXP. DATE EXP. DATE EXP. DATE OPERATIONAL TANK TANK IS R MINOR INNOR MAJOR MR - PERMIT TO OPERATE 1 2 .... ___.. CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 10 _ MONITORING SYSTEM 11 12 _ APPROVED MONITOR FREQUENCY 13 14 _ MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 _ PIPING 19 20 INVENTORY RECONCILIATION 21 22 _ TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 _ SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 _ UNAUTHORIZED RELEASES REPORTED 33 34 _ SAFETY HAZARD 35 36 _ CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL FLAMMABLE VAPORS REMOVED _ ACCESS LOCATIONS SEALED w444-�, POWER DISCONNECTED OWNER/OPERATOR MONITORING PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 _ SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS (MUST MARK ONE)FOLLOWS: T MAJOR Li MINOR rX NO LJ VIOL. VIOL. L/J VIOL OFFICE: INSP: E�L RECEIVED BY: TITLE: �.S, PHONE: RECK: �^Q HUT -3 ORIGINAL 6188 ©,