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UNDERGROUtW'ANK PROGRAM OFFICIAL INSP�ION REPORT AN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY NAME s(� 1 sroc CA 95205 COUNTY # PHONEE NNO.O. 468-3423 v W&SITE NAME: D�� ✓JINSPECTION DATE: SITE ADDRESS: ? 0 7 /i /1 /c)w CITY/STATE/ZIP ' Gr� (� CHANGES SITE/OWNER/PERMWIT? YES NO TANK D/ TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION _ SITER'COMPUT # NUMBER PER # PER# PER# PER# EXP.DATE EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS 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 9 10 MONITORING SYSTEM 11 12 APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 116 Yin I A ' ACCESS CASING SECURED 17 18 PIPING 19 20 _ INVENTORY RECONCILIATION 21 22 _ TANK GAUGING 23 24 _ APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 - SAMPUNG 29 30 APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 136 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE IML-pv REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED m 43 OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 - PIPING 48 49 ._._. ___... FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS �� SYSTEM STATUS(MUST MARK ONE) FOLLOWS: Q 57 58 59 NO VOR ❑ MINOR IOLVIOL ❑ VOL.❑ OFFICE: INSP-, Z' RECEIVED BY: TITLE: PHONE: BECK: lair n nn cinini 5/88 OM