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UNDERGROUN TANK PROGRAM OFFICIAL INSPF-TION REPORT <br /> SAN JOAGUIN HEALTH DISTRICT ./ <br /> 1601 E. HAZELTON AVE. <br /> CA 95205 <br /> COUNTY NAME UIh PHONETNO. 468423 COUNTY #3 <br /> SITE NAME: i�j INSPECTION DATE: <br /> 1 <br /> SITE ADDRESS: IG I <br /> CITY/STATE/ZIP C <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANKS TANK ?, `TJANK1 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMP €i COMPUTER <br /> NUMBER - NUMBER NUMBERn NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# �IISGI PER# PER# !NOt PER# <br /> l55 EXP.DATE" EXP.DATE 0 EXP.DATE E DATE <br /> OPERATIO AL TANK 1ANK coNrENrs <br /> MAJOR MINOR n• <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 17 118 <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 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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 JA <br /> IMPROPER ABANDONMENT 55 56 ✓ <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 58 <br /> MAJOR 57 MINOR NO 59 <br /> VIOL VIOL LJVIOL❑ <br /> OFFICE: INSP. � REC <br /> TITLE: E ,/� NE: G' RECK: <br /> HUT-3 ORIGINAL 5/W GM <br />