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UNDERGROUNWANK PROGRAM OFFICIAL INSP ION REPORT P IQ�G 2 <br /> AN JOAQUIN HEALTH DISTRICT ! <br /> ,� 1601 E. HAZELTON AVE. <br /> COUNTY NAME P ONE NO. 468-3423 8OCKTON, CA 93423 COUNTY # / <br /> SITE NAME: INSPECTION DATE: l <br /> SITE ADDRESS: y�� M�UN s,7 CITY/STATE/ZIPjeN/w CjS%fes <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK -Z_ TANK �1 TANK <br /> FORM AAND/OR B SUBMITTED? COMPUT COMPUTER COMPUTE COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> T(Y,IpE OF INSPECT N SITE COMPUTER# PER # PER# PER# PER# <br /> �.t ' 3 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TS <br /> MI <br /> OPERATIONAL TANK <br /> TANK co N <br /> MAJOR MINORR <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 lgx 20 <br /> INVENTORY RECONCILIATION 21 22 �— <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 _ <br /> SAMPUNG 29 T <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 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <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 /> -7IMPROPER ABANDONMENT 55 56 _ <br /> THE MARKED <br /> ITITEEMMS� REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 15 �0 " Z <br /> �. <br /> MAJOR 57 MINOR 58 59 <br /> NO <br /> VIOL. VIOL. ❑ - VIOL.❑ <br /> OFFICE: INS P RECEIVED BY: <br /> TITLE: PH E: CK: <br /> HUT-3 ORIGINAL <br />