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UNDERGROUP'1 TANK PROGRAM OFFICIAL INSP 'TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICI,_ <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME J0 POCA 95205 <br /> HONNEE NNO. 468-3423 COUNTY # <br /> 1A�N PO. <br /> SITE NAME: i (O� INSPECTION DATE: zl1vG <br /> SITE ADDRESS: �ZO S CITY/STATE/ZIPS^t jj CA <br /> I l <br /> CHANGES SITE/OWNER/PERMIT? NO TANK TANK OTANK TANK <br /> FORM A AND/OR B SUBMITTED? S COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> UaJ 101 V EXP DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR I MINOR <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 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 _ <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 I 1 <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 <br /> SYSTEM STATUS(MUST MARK ONE) Na Vi 0(a}/eN.P - FOLLOWS: D c ILec : j'/3/6r,, <br /> a�D• •/z r/6 _ <br /> Oa<urrcl dutvq vewvwl' , la u io, ICecla^ <br /> MAJOR 57MINOR 58 NO 59 r/•>' ' "Ytw "C/t4'- <br /> VIOL. ❑ VIOL ❑ VIOL❑ �y •{aI i a _ <br /> of ip rKksoN N kcAm C4 23s-< ma! st� a& a <br /> OFFICE: INSP:CI %S �{kN-(— RECEIVED Bt: <br /> TITLE: �, FI-� PHONE: RECK: <br /> HUT-3 ORIGINAL Brae OM <br />