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UNDERGROU TANK PROGRAM OFFICIAL INSP'TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME �'p P ONE NO. 46893423 COUNTY #(10- LL <br /> SITE NAME: & Ile ge ,/'i na o Ke t" INSPECTION DATE: /� <br /> SITE ADDRESS/0� 1 45, f¢^I oso. CITY/STATE/ZIP ,�j�'Xy�� (v,� �,5a0,5 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK 471 TANK 03 TANK p_t' TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# ,aA 39 PER# A ON5 PER# a a S f PER# <br /> 00 AA 1 J EXP.DATE EXP DATE EXP,DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <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 µ <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 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 N <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 DISCONNECTED43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS r55 <br /> 47 <br /> PIPING 49 <br /> FLAMMABLE VAPORS REMOVED r�j� 1 o r <br /> UNAUTHORIZED RELEASE 52 _. <br /> SAMPLING } --- -�_ -- -- --... <br /> IMPROPER ABANDONMENT 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAJONO <br /> VIOL..R LiVIOLL..R ❑ VIOL.❑ _ <br /> OFFICE: 1 INSP: RECEIVED BY: - <br /> 4t" QsC <br /> TITLE: Cu �J� PHONE: BECK: <br /> s/aa <br /> HUT-3 U ORIGINAL <br /> 101 <br />