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UA17ERGROUND TANK OFFICIAL INSPECTION REPORT <br /> SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N.San Joaquin Street <br /> COUNTY NAME <br /> Mailing Address: <br /> CA'96201 03eeee <br /> 465-3420 COUNTY # <br /> SITE NAME: rayl va ,LA INSPECTION DATE: <br /> SITE ADDRESS:/v4j &nom• ALw t /� CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK [� TANK �� TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPE'ION SITE COMPU'R# NUMBER NUMBER NUMBER NUMBER <br /> (/�•/e�_yyy� { L G C� PER# PER# PER# PER# <br /> '/ 7 / EXP.DATE EXP_DATE EX/P.DATE EXP.DATE <br /> OPERATIONAL TANK WK CONTENTS <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 7- <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 - -- <br /> 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 W4445 <br /> FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMO d01J9MATERIALS r4T6 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 /> MAJO58 <br /> R 57 MINOR NO 59 <br /> VIOL ❑ VIOL. ❑ VIOL IJ <br /> OFFICE: IN P: RECEIVED BY: <br /> TITLE: PHONE: PECK: <br /> HUT-3 White-Original Yellow-Owner's Copy Pink-File Copy Sias nM <br />