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UNDERGROUtTANK PROGRAM OFFICIAL INSP&TION REPORT <br /> AN JOAQUIN HEALTH DISTRICTmw <br /> 1601 E. HAZELTON AVE. <br /> 205 <br /> COUNTY NAME PHO ETONNO. 468 3423 COUNTY # j S <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: 0 p0 w`, / CITY/STATE/ZIP z �'�vo <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM AAND/ORB SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # !" J PER # PER # PER # <br /> EXP DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 - <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 131/r,20 <br /> MONITORING RECORDS MAINTAINED 15 ACCESS CASING SECURED 17 PIPING 19INVENTORY RECONCILIATION 21TANKGAUGING 23 <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 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED m 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 /> 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 /> MAJOR 57 MINOR 58 NO 59 l '� <br /> VIOL L"J VIOL ❑ VIOL❑ <br /> OFFICE: ^ n INSP:�_// p n RECEIVED BY: <br /> 6J2tr TITLE: Zj PHONE: RECK: <br /> HUT-3 ORIGINAL 5/88 OM <br />