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UNDERGROU NK PROGRAM OFFICIAL INSP N REPORT <br /> N JOAQUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME POCA 95205 <br /> HONNEE NO. 468-3423 COUNTY # :5 ct <br /> �o�L�/� PO. <br /> SITE NAME: /� y-� <77AF INSPECTION DATE: 611-119` / <br /> SITE ADDRESS: �1/� CITY/STATE/ZIP��� /Kv <br /> CHANGES SITE/OWN ER/PERMIT? YES NO TANK ( TANK y TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# PER# PER# <br /> �OLITZN EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MNK CON NM <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 /> ... .. __. <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS J31132UNAUTHORIZEDRELEASES REPORTED SAFETY HAZARD CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <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 /> OPER ABANDONM 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: SXj6: Y!^� <br /> MAJOR X57 MINOR 58 NO 59 <br /> VIOL. LI VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP:x/ fe,,? RECEIVED BY: <br /> TITLE: 5�. A/ > PHONE: RECK: <br /> (2«M) �16s- 3� <br /> HUT-3 ORIGINAL ea 0, <br />