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UNDERGROUN" TANK PROGRAM OFFICIAL INSPFt'TION REPORT *w6AN JOAQUINHEALITH DISTRICT 1601 E.COUNTY NAME AVE. Wool STOC 95205 COUNTY #3g PHONEE NO.NO. 46 468-3423 SITE NAME: O SINSPECTION DATE: FN 7n/c /O23 O SITE ADDRESS: lrSf CITY/STATE/ZIPS L1v� CHANGES SITE/OWNER/PERMIT? YES TANK TANK TANK N TANK FORM A AND/OR B SUBMITTED?—11-3D COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYP OF IN§PECTION SITE COMPUTER# PER# PER# PER# PER# 71�PRoo EXP.DATE EXP DATE EXP.DATE EXP.DATE OPERATIONAL TANK UNKCO NIS MAJOR f MINOR PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 10 MONITORING SYSTEM 11 APPROVED MONITOR FREQUENCY 13 14 _ MONITORING RECORDS MAINTAINED 1 16 ACCESS CASING SECURED 17 18 PIPING 19 20 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 _ APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL &44 39 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED 42 POWER DISCONNECTED 43 _ OWNER/OPERATOR MONITORING 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: MAJOR 57 MINOR 58 NO 59 VIOL VIOL ❑ VIOL❑ OFFICE: INSP: Airy / RECEIVi�v Y ` AMe Aa9--sass- 3'010 TITLE: 0- 5 PHONE: RECK: HUT-3 ORIGINAL siae GM