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UNDERGROUTANK PROGRAM OFFICIAL INSP I <br /> TION REPORT <br /> ISSAN JOAQUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMESc� sTocKroN, cA s52os COUNTY # <br /> �Q� PHONE NO. 468-3423 <br /> SITE NAME: 1 e n erg r SA6 r 'e— INSPECTION DATE: 3' <br /> ERI ) 15-s <br /> SITE ADDRESS: / / 6 7 1.11 o:� CITY/STATE/ZIP �� 5 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK d ! TANK 6 >- TANK E7 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER # <br /> I)" p (�(�`f'"1 KA, ' I (O I EXP.DATE EXP.DATE EXP_DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONfEN 5 r DL�U• <br /> MAJOR MINOR n <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 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 138 139 <br /> FLAMMABLE VAPORS REMOVED 140 <br /> ACCESS LOCATIONS SEALED 141 142 <br /> POWER DISCONNECTED <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 /> _... .. _.. <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:58 <br /> MAJOR 57 MINOR NO 59 <br /> VIOL VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: <br /> re <br /> ONp <br /> TITLE: S R EE HS PH vC-4LTGYt <br /> HUT-3 ORIGINAL t, <br />