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UNDERGROUN*ANK PROGRAM OFFICIAL INSPF�ION REPORT AN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE.CA g COUNTY NAME PHONETNO. 468934203 COUNTY # J SITE NAME: IINSPECTION DATE:6 27 SITE ADDRESS: '7gd1 CITY/STATE/ZIP CHANGES SITE/OWNER/PERMIT? YES NO-- ANK TANK NK TANK FORM A AND/OR B SUBMITTED. 61 COMPUTER COMPUTE COMPUTER COMPUTER NUMBER NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE CO PUTER# PER# PER# PER# PER# /0 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 16 _ 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 - SAMPLING 29 30 _. APPROVED TANK REPAIRS 31 32 _ UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMCVAL OF RESIDUAL &t7- 777777777777777 -- FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/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 ..--_.- __ _ _ _ __ _ -------- IMPROPER __-- .IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REP SE;4T VIOLAILONS AND WST BE CORRECTED SYSTEM STATUS(MUST MARK ONE) FOLLOW A.iyLl`/—!'li All MAJOR 57 MINOR 58 NO 59 VIOL. ❑ VIOL. ❑ VIOL. z All OFFICE: INSP: RECEIVED ¢Y: TITLES PHONE: REGK: siea HUT-3 ORIGINAL