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UNDERGROI IND TANK PROGRAM OFFICIAL INS TION REPORT <br /> `.h SAN JOAQUIN HEALTH DISTRIX <br /> 1601 E. HAZELTON AVE. 9 <br /> COUNTY NAME PHONETNO. 468 CA 3 23 205 COUNTY # / <br /> SITE NAME GV ` t G�//ll G i/�G INSPECTION DATE: 6jZ5 y3 <br /> SITE ADDRESS: M / S CITY/STATE/ZIP )r,, 4!51-1 <br /> CHANGES SITE/OWNER/PERMIT?' YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTE(] �,4/�0 COMPUTER COMPUTER COMPUTER <br /> NUMBER W NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTEft# PER# jeS'� PER# PER# PER# <br /> Rom)OLZ� lrlie� t7 7P77 EXP.DAT EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK T KCONTENrs <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 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 h <br /> TANK GAUGING 23 24 / V <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPUNG 29 30 <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 W43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED _ <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <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 /> SAMPUNG 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REP I AND MU BE COR -CTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOL OWS: V E K <br /> end t iJ N ltJ <br /> MAJOR 7 MINOR 58 NO 59 S G i ✓ L L <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> , <br /> L O Ar,-JO 9 Z <br /> ✓tG7S. <br /> OFFICE: INSPZIV RECEIV D B6�7 <br /> //�/ <br /> TITLE: S'f4ifS PHONRECK: <br /> HUT-3 ORIGINAL sees O <br />