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PROGROW <br /> UNDERGROUfMTAAIN�OAQUIN HEALTH DI STRICTWION REPORT <br /> W$ 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKPHONETON, CA NO. 4 893423 COUNTY # J c <br /> SITE NAME: INSPECTION DATE: j�jr <br /> SITE ADDRESS: 972CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK o ( TANK O 2� . TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTIONSITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> �or�N� PER# PER# PER# PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE R12 <br /> CHANGE IN CONDITIONS TO OPERATE APPROVED CONSTRUCTION WRITTEN MONITORING PROCEDURES APPROVED MONITORING SYSTEM MONITORING SYSTEM APPROVED MONITOR FREQUENCY MONITORING RECORDS MAINTAINED -""- -- -- <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 _"-- -- <br /> 29 30 <br /> APPROVED TANK REPAIRS 31 32 -- - - <br /> UNAUTHORIZED RELEASES REPORTED 33 34 - -- ----- -- <br /> SAFETY HAZARD 35 36 - <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED - <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED - - <br /> OWNER/OPERATOR MONITORING -__- - -- - <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 g.. <br /> PIPING 48 49 -- <br /> FLAMMABLE VAPORS REMOVED 50 - -- <br /> UNAUTHORIZED RELEASE 51 52 - - — <br /> SAMPLING '" --- -- -- <br /> 53 54 - <br /> IMPROPER ABANDONMENT 5 56 - - <br /> SYSTEM STATUS(MUST MARK ONE) THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> FOLLOWS: <br /> MAJOR 57 MINOR 8 NO 59 <br /> VIOL VIOL. VIOL❑ <br /> OFFICE: INSP: % RECEIVED BY: <br /> YEN A- <br /> TITLE: � '� 'n S PHONE: <br /> RECK: <br /> HUT-3 ORIGINAL sise O <br />