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TANK PROGRAM OFFICIAL <br /> UNDERGROUI&SAN JOAQUIN HEALTH D STR CT4W REPORT <br /> 1601 E. HAZELTON AVE. <br /> CA 9525 <br /> COUNTY NAME P ONETNO. 468-34203 COUNTY # <br /> SITE NAME: �� INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES N TA K TANK TANK TANK <br /> FORM A AND/ORB SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER 10(>,7 „D NUMBER NUMBER NUMBER <br /> _ PER # �''�` PER# PER # PER# <br /> ��k %Cn9/�l//f� EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK R MIN Ts <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 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 /> SAMPUNG 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 /> NO <br /> VIOL MAJOR ❑ VIOMINL ❑ VOL.❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> C <br /> TIT PHONE: BECK: <br /> HUT-3 ORIGINAL alae ©M <br />