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UNDERGROUN NK PROGRAM OFFICIAL INSIDE ON REPORT <br /> WN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> CA 205 <br /> COUNTY NAME PHONETONNO. 468-3423 COUNTY # <br /> SITE NAME: # INSPECTION DATE: <br /> Jciza/cs x x �/ <br /> SITE ADDRESS: A/ Poo W CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO ANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER &Xj�L, NUMBER /&00— NUMBER /&_OV NUMBER <br /> TYPE OF INSPECTION ISITE COMPUTER# PER# DI PER # OZ PER # p PER # <br /> unk /G O D EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TaNKcorMINOR <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 /> SAMPUNG - 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 &41 <br /> 39 _ <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 42POWER DISCONNECTED 43L <br /> PE 45 <br /> MANENT TANK CLOSURE <br /> OFR bIDUAL IALS 46 47 <br /> PIPING <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLI 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: z6'Al v <br /> 59 ae <br /> MAJ <br /> OR 57 MINOR 58 NO <br /> VIOL. LJVIOL ❑ VIOL <br /> OFFICE: INSP: /� _ O� RECEIVED BY: <br /> TITLE: c ��//,� ��yy PHONE: <br /> O' � RECK: <br /> 4nY. MGl6 4 S <br /> HUT-3 ORIGINAL sine O <br />