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UNDERGROUN^ TANK PROGRAM OFFICIAL INSPF^TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> ,�/ �+ 1601 E. HAZELTON AVE. �QY Zr� 2 <br /> COUNTY NAME y��/Y. -fWL�A&uWoNETNO. 468ON, CA 934203 / •f j-3 <br /> �O ���N�r # <br /> INSPECTION DATE: <br /> SITE NAME: �J �/ <br /> SITE ADDRESS: I" 1 i CITY/STATE/ZIP G � S 7 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TA K TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER p NUMBER NUMBER NUMBER <br /> TYPE INSPEC ON SITE CO.M/P�UTER# pER # )� PER# PER# PER# <br /> / EXP.D EXP.DATE EXP,DATE EXP.DATE <br /> TANK CONTENTS - •' *� " 4 -' <br /> OPERATIONAL TANK MAJOR MINOR _ 'm <br /> ,P <br /> PERMIT TO OPERATE 1 2 _ <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 #E] <br /> APPROVED MONITORING SYSTEM 9 <br /> MONITORING SYSTEM 11 <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 27 128 1 _ <br /> SAMPLING 29j30 <br /> APPROVED TANK REPAIRS 312 <br /> UNAUTHORIZED RELEASES REPORTED 334 <br /> SAFETY HAZARD 356 <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W142 <br /> FLAMMABLE VAPORS REMOVEDACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> 7 <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 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKE MSR PR SENT VIOLATIONS AND MUST E CORRECTED S <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS- IrJ <br /> 7 58 59 <br /> MAJOR MINORNO <br /> VIOL VIOL ❑ VIOL❑ <br /> OFFICE: r INSPW RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> 1UT-3 D 'V ORIGINAL siee O» <br />