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UNDERGRWD TANK PROGRAM OFFICIAL INJECTION REPORT <br /> SAN JOAQUIN HEALTH DISTRI <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKPHONETNO. 468-3423 <br /> COUNTY # <br /> SITE NAME: - INSPECTION DATE: 6 _g <br /> SITE ADDRESS: 5 ���„ CITY/STATE/ZIP le ' on r�36 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER #-I"/'186'Oi PER # PER# PER# <br /> G 44 iPv+s.7v Po EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TAR0-RMCONNINO <br /> MAJOR FMR <br /> R <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 <br /> APPROVED TANK REPAIRS - 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED pffil, 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4142 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING — <br /> PERMANENT TANK CLOSU E <br /> REMOVAL SIDUAL IAL 46 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: tr 6;6 <br /> f o <br /> MAJOR 57 MINOR 58 NO 59 "- '` <br /> VIOL. ❑ VIOL. ❑ VIOL va oT/1 <br /> J <br /> OFFICE: INSP: il. . _� RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> 1169 S- -..j-q 4 <br /> HUT-3 ORIGINAL siea ©, <br />