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UNDERGROUWTAN <br /> K PROGRAM OFFICIAL INSPi�TION REPORT <br /> JOAQUIN HEALTH DISTRICTW <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME ' ,,,, �,� PHOONE NO. 468-3423 COUNTY # <br /> SITE NAME: INSPECTION DATE: Z �. <br /> SITE ADDRESS: CITY/STATE/ZIP ,`r'',�! <br /> 3 Vic: <br /> CHANGES SITE/OWNER/PERMIT? YES ANK TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBERA/ NUMBERS NUMBER NUMBER <br /> TYPE INSPECTION SITE COMPUTER# PER# n� PER# �7 PER# PER # <br /> Aloi�� <br /> EXP.DATE.��v EXP-DATE EXP.DATE EXP DATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK 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 1 4 1L <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 38 139 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED <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 53 154 —.- <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP�4 RECEIVED Y: <br /> TITLE: PHONE: RECK: <br /> .HUT_3 ORIGINAL <br />