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UNDERGROUND TANK PROGRAM OFFICIAL INSPECTION REPORT <br /> IN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUN?Y NAME STOCPHONE NO. 468-3423 ON, CA 3 COUNTY # J <br /> SITE NAME: D D -#iA-o � w INSPECTION DATE: / p <br /> SITE ADDRESS: HW J 1J' uS Luc�p Zt+ y <br /> 8�j /� CITY/STATE/ZIPS <br /> CHANGES SITE/ YES NO TANK TANK TANK ` TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMP R# NUMBER NUMBER NUMBER NUMBER <br /> -// / �}' PER# PER# PER# PER# <br /> 7r(� ` 3 V EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK C NTFwm <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS 1b OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES ---- <br /> APPROVED MONITORING SYSTEM 9 10 —� -- - --- <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREOUENCY 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 23 124 1 — -'- - <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 . w>Y Mu{Tyr' f i r ; <br /> REMOVAL OF RESIDUAL N4445 <br /> 9 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 2 <br /> POWER DISCONNECTED 3 - <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE a "r <br /> ;IA {f ik 'lx^ wa PRIF <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 ITEMS REPRESENT VIOLATIONS AND MUST BE C RRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: r <br /> MAJOR 57 MINOR 58 59 <br /> NO <br /> VIOL ❑ VIOL ❑ VIOL <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> PIIT-? <br />