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UNDERGROU' ' TANK PROGRAM OFFICIAL INSP' 'TION REPORT <br /> USAN JOAQUIN HEALTH DISTRICTa/ <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMES" dia STOCK�P,HONEETNO. 4 893423 5205 COUNTY # <br /> SITE NAME: R jmod�� B Q G/i--Xu C_. INSPECTION DATE: J + <br /> SITE ADDRESS: 6 D 14 vu /Qyv CITY/STATE/ZIP�'f C4 �51Q <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK D / TANK 6>;. TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTE COMPUTER COMPUTER <br /> NUMBER 1!� 1 5 NUMBER 5 S NUMBER NUMBER <br /> TYPE OF INSPECTION SRE COMPUTER# PER # PER# PER# PER# <br /> eSU'jEXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK coNrENlS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 'S <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 13l4 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 118 <br /> PIPING 19 120 <br /> INVENTORY RECONCILIATION 21 22 lea _. <br /> TANK GAUGING 23 124 _ <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 128 1 _ <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 46 147 <br /> PIPING 4849 -- -- <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 <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 1 ✓��MINORNO 4 <br /> �f <br /> 57 58 59 <br /> VIOL R ❑ VIOL ❑ VIOL❑UA <br /> �— <br /> i <br /> OFFICE: INSP: RECEIVE BY: <br /> TITLE: PHONE: BECK: <br /> HUT-3 ORIGINAL sig � <br />