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UNDERGROUf TANK PROGRAM OFFICIAL INSP�ION REPORT <br /> 7 AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME PHo ETNO. 468-3423 CA 95205 COUNTY # <br /> SITE NAME: 'tom? INSPECTION DATE:�a <br /> SITE ADDRESS: II CITY/STATE/ZIP e3cpuc�� q 0 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK DI NK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER C MPUTER COMPUTER COMPUTER <br /> NUMBER N BER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # PER PER # PER # <br /> EXP.DATE EXP. TE EXP.DATE EXP.DATE <br /> NTENM <br /> OPERATIONAL TANK TAJORNK MINOR <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 k2l <br /> 12 .. ._.. .... <br /> APPROVED MONITOR FREQUENCY 14 <br /> MONITORING RECORDS MAINTAINED 16 <br /> ACCESS CASING SECURED 18 <br /> PIPING 20 <br /> INVENTORY RECONCILIATION 22TANK GAUGING 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 742 <br /> SAMPLING <br /> APPROVED TANK REPAIRS <br /> UNAUTHORIZED RELEASES REPORTED <br /> SAFETY HAZARD _ _ <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL - 3B W 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 148 149 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE <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 /> 58 <br /> MAJOR 57 MINOR NO 9 <br /> .VIOL ❑ VIOL ❑ VIOL - <br /> OFFICE: INSP:, Sr RECEIVED BY: <br /> TITLE: RNIT7ditT/ PHONE: RECK: <br /> HUT-3 ORIGINAL 5188 OM <br />