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UNDERGROUI)TANK PROGRAM OFFICIAL INSPWIION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> 205 <br /> COUNTY NAME ,�5a ' JV PHONETNO. 468 3423 COUNTY # 17 <br /> SITE NAME: Hbr+by) + INSPECTION DATE: <br /> SITE ADDRESS: 38 W° 5 CITY/STATE/ZIP,90 <br /> CHANGES SITE/OWNER/PERMIT? YES ` ,oNCO TANK 0 ) TANK TANK 03 TANK <br /> oq <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYFF INSPECTION SITE COMPUTER# PER# 0 70�U20P_ PER # M Ei <br /> FYI n� PER# `05/) PER# <br /> o0 1n'2-, 1 1 2 5Lf EXP.DATE EXP DATE EXP DATE EXP DATE <br /> OPERATIONAL TANK TANK CONTENTS1� <br /> MAJOR MINOR { ` <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 16 - <br /> WRITTEN MONITORING PROCEDURES 137 8 <br /> APPROVED MONITORING SYSTEM 10 <br /> MONITORING SYSTEM 12 <br /> APPROVED MONITOR FREQUENCY 14 <br /> MONITORING RECORDS MAINTAINED 16 <br /> ACCESS CASING SECURED 18 - <br /> PIPING 20 <br /> INVENTORY RECONCILIATION 22 <br /> TANK GAUGING 24 _ <br /> APPROVED RESPONSE PLAN 26 _ <br /> UNAUTHORIZED RELEASE OCCURRENCE 28 <br /> SAMPLING 30 <br /> APPROVED TANK REPAIRS 32 <br /> UNAUTHORIZED RELEASES REPORiEb 34 <br /> SAFETY HAZARD 36 <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 36 39 <br /> FLAMMABLE VAPORS REMOVED <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 /> ..� _.._ <br /> SAMPLING53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM SZST MARK ONE) FOLLOWS:MAJOR MINOR 58 NO59 <br /> VIOL. VIOL. ❑ VIOL❑ <br /> OFFICE: INSP: RECEIVED BY: / <br /> TITLE: PHONE: R CK: <br /> HUT-3 ORIGINAL 5/88 ©" <br />