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UNDERGROUN') TANK PROGRAM OFFICIAL INSPF^.TION REPORT <br /> "SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME �y7p_y� ` y(� PONE NO. CA 95205 COUNTY # 9 <br /> v1/�- PHONE NO. 468-3423 <br /> SITE NAME: S " INSPECTION DATE: / <br /> SITE ADDRESS: T� �� CITY/STATE/ZIP sf C� /-�aljS <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK 0 TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTTIIIO,N//'/ SITEOMP T/E_R# NUMBERa` �/ NUMBER NUMBER NUMBER <br /> " 3 (a / EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK m KCONTEWS <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 -- - <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN TT- <br /> UNAUTHORIZED 26 <br /> 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 /> 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 69 <br /> VIOL. ❑ VIOL- ❑ VIOL.El ~ - <br /> OFFICE: INSP: RECEIVED BY: <br /> TI LE: a <br /> ONE: RECK: <br /> HUT-3 ORI INAL , 5/W 01 <br />