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UNDERGROUl" TANK PROGRAM OFFICIAL INSPF" TION REPORT <br /> `, N JOAQUIN HEALTH DISTRICT <br /> J <br /> Sad 1601 E. HAZELT 9 AVE. <br /> CA <br /> COUNTY PHONET468-3423 <br /> NO. 5205 COur # <br /> NAME <br /> SITE NAME: I I r �i INSPECTION DATE: -2 <br /> SITE ADDRESS: l V {� CITY/STATE/ZIP 9n2 <br /> CHANGES SITE/OWNER/PERMIT? YES N 'TANK D.Z TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER V C� COMPUTER COMPUTER OMPUTER <br /> NUMBER NUMBER NUMBER UMBER <br /> TYPE F INSPECuunnnON �$J�TE COMPUTER# /�/ PER# PER# PER# PER# <br /> VbIA�1lSC.J 1 R 2,blt EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TI WK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 -- <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION5 6 _ <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> 1 <br /> MONITORING 12ORING SYSTEM V_ <br /> APPROVED MONITOR FREQUENCY E11 <br /> MONITORING RECORDS MAINTAINED 15 116 <br /> ACCESS CASING SECURED 17 18 _ <br /> PIPING 19 20 _ <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 2 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 138 139 <br /> FLAMMABLE VAPORS REMOVED 40 _ <br /> ACCESS LOCATIONS SEALEDN44 � <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 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEM REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS <br /> S((MUST MARK ONE) FOLLOWS: v <br /> 58 <br /> MAJOR 1tY MINOR NO 59 <br /> VIOL. LYJ VIOL ❑ VIOL❑ <br /> OFFICE: INSP: n y� RECEIVED BY: <br /> Will V*kft '� <br /> TITLE: ,�, �� ' PHONE: R K: <br /> 1 <br /> HUT-3 ORIGINAL <br />