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UNDERGROUf4 'ANK PROGRAM OFFICIAL INSPE' iON REPORT <br /> b <br /> 4t*4AN JOAQUIN HEALTH DISTRICT +mol <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 CQIIIITI # <br /> COUNTY NAME PHONE NO. 468-3423 <br /> SITE NAME: &W psv7V <br /> INSPECTION DATE: f,3 <br /> SITE ADDRESS: 1 (� I 6XG�N-r &,,- CITY/STATE/ZIP ( <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK ?/ TAN TANK <br /> FORM A AND/OR B SUBMITTED? NUMBER COMPUTER COMBER ' �c MBERER <br /> NUMBER - /� NUMBER�S� <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> EXP.DATE- EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK <br /> MAJOR 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 <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 /> - <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 _ <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: <br /> 57 58 59 <br /> MAJOR lAONOR VIOL <br /> VIOL <br /> OFFICE: INSP: RECEIVED BY: <br /> TITL&e PHONE: BECK: <br /> HUT-3 ORIGINAL seas O <br />