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UNDERGROUNI' TANK PROGRAM OFFICIAL INSPE^TION REPORT <br /> aN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> CA 5205 <br /> COUNTY NAME PHONETNO. 46893423 COUNTY # <br /> SITE NAME: L INSPECTION DATE:/O„';/-f(1/f <br /> SITE ADDRESS: �j' ��G W �f I /STATE/ZIP G (� 9V 7( <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER 5G Oe�l NUMBER NUMBER NUMBER <br /> SITE <br /> TYP F INSPECTION COMPUTER <br /> �#j PER# / PER# PER# PER# <br /> If J EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TAW OPERATIONAL TANK MAJOR <br /> MI NTNO <br /> MAAJOR MIR <br /> R <br /> PERMIT TO OPERATE 19 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 K37 <br /> APPROVED MONITOR FREQUENCY _ <br /> MONITORING RECORDS MAINTAINED <br /> ACCESS CASING SECURED _ <br /> PIPING <br /> INVENTORY RECONCILIATION AA- <br /> TANK _ <br /> GAUGING <br /> APPROVED RESPONSE PLAN _ <br /> UNAUTHORIZED RELEASE OCCURRENCE <br /> SAMPUNG <br /> APPROVED TANK REPAIRS 2 <br /> UNAUTHORIZED RELEASES REPORTED 4 <br /> SAFETY HAZARD 6 <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W142 <br /> FLAMMABLE VAPORS REMOVEDACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <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 MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS O / <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> s �'� /2T /MM�E4/ G <br /> MAJOR 57 MINOR NO 58 59 Y (� <br /> VIOL. ViOI. LlVIOL Li ` G( i►�.� <br /> dA ew <br /> OFFICE: INSP:�-/ RECEIV DBY: <br /> TITLE: /?rl,415 PHONE: RECK: <br /> HUT-3 ORIGINAL <br />