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UNDERGROW TANK PROGRAM OFFICIAL INS� TION REPORT <br />SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />OUVI\I I RIIRIC . Iv11 wrv, um .YOzuO COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: l5 o, / <br />/ / INSPECTION DATE: <br />SITE ADDRESS: 610 ( CITY/STATE/ZIP 9S <br />CHANGES SITE/OWNER/PERMIT? YES NO TANK C / TANK TANK TANK <br />FORM A AND/OR B SUBMITTED? COMPUTER I COMPUTER COMPUTER COMPUTER <br />TYPE OF INSPECTI N SITE COMPUTER # NUMBER NUMBER NUMBER NUMBER <br />PER # PER # PER # PER # <br />EXP. DATE EXP. DATE EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />ENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING29 <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />TANK CONTENTS <br />MAJOR MINOR <br />PIPING <br />38 39 <br />--- <br />49 <br />1 2 <br />40 <br />-- <br />---- <br />- --- <br />- <br />- <br />""" <br />_ <br />_ ... <br />3 4 <br />5 6 <br />52 <br />7 8._ <br />53 <br />54 <br />9 10 <br />55 <br />56 <br />11 12 <br />-- '---- <br />--- <br />13 14 <br />- - <br />15 16 <br />17 18 <br />- <br />19 20 <br />_.......... <br />_ <br />21 22 <br />23 24 <br />._... <br />... ___... <br />25 26 <br />27 28 <br />31 32 <br />- <br />- <br />33 34- <br />- <br />- '-- <br />35 36 <br />----""'-- <br />" <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />38 39 <br />--- <br />49 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />41 42 <br />43 <br />44 45 <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />SYSTEM STATUS (MUST MARK ONE) <br />58 <br />MAJOR 57 MINOR NO 59 <br />VIOL El VIOL. ❑ VIOL ❑ <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: '? d <br />nvar:{G li ED BY: <br />Tv� <br />TITLE: p , / C PHONE:,4,, DA.3 RECK: <br />UHIUINAL 5/85 ©� <br />