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vlwls�.x�wluv..� x IftIN" x'fti�.YA,a:'liH.iyi iJ't`S'i4,+7}a1P., i1Ctb' IkJilE <br /> SAN JOAQUIN HEALTH DISMIC,.-/ <br /> 1601 E. HAZELTON AVE. <br /> . Y NAN <br /> STOCKONCA 95205 <br /> PHONE TNO. 468-3423 COUNTY # <br /> SITE NAME: 7 INSPECTION DATE: <br /> SITE ADDRESS: ' v 3 _ CITY/STATE/ZIP — <br /> CHANGES SITE/OWNER/PERMIT? YES TANK TANK TANK TANK <br /> ORM A AND/OR B SUBMITTED?--.' •P_ COMPUTER / COMPUTER COMPUTER J COMPUTER <br /> TYPE OF INSPECTION I SITE COMPUTER♦ NUMBER NUMBER NUMBER NUMBER <br /> . P PER / PER • PER xI " PER N <br /> P / � Ry� EXP HATE/' (l EXP-SATE EXP DATE EXP DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR WNOR <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 M NITORING SYSTEM 9 10 <br /> MONITORING YSTEM 11 12 --- <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 --- <br /> ACCESS CASING SECURED 17 16 -- <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 9- 30 <br /> APPROVED TANK REPAIRS 31 32 i <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD 35 136 <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 43 <br /> OWNER/OPERATOR MONITORING 44 45 _ <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING48 49 <br /> FLAMMABLE VAPORS REMOVED 50 ' /U <br /> �1 -- <br /> UNAUTHORIZED RELEASE 51 52 (] �y apt <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 Z b <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: �� x - " 42— fey [ <br /> MAJOR58 57 <br /> MINOR NO �, <br /> VIOL VIOL ❑ VIOL❑ <br /> d Li <br /> O CE: INSP-. J RECEIVEb BY: _ <br /> TIl9 PHONE: RECK: <br /> ,KENS0,0 -3 '08(eQ <br /> HUT-3 OWNER'S COPY s w ©M <br />