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UNDERGRCWDJCK PROGRAM OFFICIAL INMECWN REPORT JOAQUIN HEALTH DISTRIM 1601 E. HAZELTON AVE. COUNTY NAME PHONE T NO. 468 3423 COUNTY # 3< SITE NAME: M 1 UTT3 M 0-nCIJ_ INSPECTION DATE:/f- SITE ADDRESS: d w ? //� �!/ ('� CI`TYY/STATE/ZIP eA—?T37/ CHANGES SITE/OWNER/PERMIT? YES ! NO TANK I TANK '7i TANK TANK b FORM A AND/OR B SUBMITTED? COMPUTER] COMPUTE�j COMPUTER COMPUTER TYPE NSPECT ON SITE COMPUTER# NUMBER NUMBER (70 NUMBER NUMBER PER # PER# PER # PER # 77 EXP.DA E EXP.DATE C EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENM MAJOR MINOR PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM - ---- MONITORINGSYSTEM 11 12 -- - -" _ APPROVED MONITOR FREQUENCY 13 14 - -"- "- - MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 - - ------ PIPING 19 20 TORY RECONCILIATION 21 22 TANK GAUGING 23 24 - _� APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 --- - - "` - SAMPLING 29 30 D TANK REPAIRS 71--32 - - UNAUTHORIZED 132UNAUTHORIZED RELEASES REPORTED 33 SAFETY HAZARD 35 36 CONDITIONS ABATED 37 - _-_-- - - TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL P4445 9 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED - 2POWER DISCONNECTED 3OWNER/OPERATOR MONITORING PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 --. _ -. -. MPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: to MAJOR 57 MINOR 58 NO 59 VIOL. VIOL ❑ VIOL.❑ OFFICE: 2INSD/ RE IVED �� S P E: RECK: HUT-3 ORIGINAL 5/88 Q m