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Post-It"brand <br /> FaxTransmiftai Memo 7672 No.of Pages Today's Date Jf /�I Time <br /> Ta From <br /> Company 1 �^ <br /> l'y l0�c C.�r" 44_14_54 ` Company ,,4W5 <br /> ,4W5y <br /> Location � Location 574- Dept.t' 9 Char e PDt <br /> Fax# Telephone# Fax# <br /> Telephone# <br /> Comments <br /> G ` Original <br /> Disposition: ❑Destroy �Return �Call for pickup <br /> C l/ � t rv:1 14tk r 14, _7- ,,fee, 194-1f."k, on <br /> n ' �� <br /> U[J lG�r C G�r�r r t t., y Ott l /44/.e, S' Lar/ 7' �r kc � / C� IC y� <br /> Y' f! /'Gfr�!c.sr+, friYi� <br /> UNDERGR'— " D TANK PROGRAM OFFICIAL IV" CTION REPORT <br /> SAN JOAQUIN HEALTH DISTR <br /> 3601 E. HAZELTON AVE. <br /> COUNTY NAIVE P ONE NO. 46s 342035 COUNTY # <br /> SITE NAME: K �L INSPECTION DATE: /Z <br /> SITE ADDRESS: �01 E_ CITY/STATE/ZIP <br /> S'�r `c�1,C/� £z p z <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK s [ TANK .z—' L_ TANK 3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER s vrrGt7 NUMBER 5,q 4vL GL> NUMBER ML6- NUMBER <br /> PER# PER# PER# PER# <br /> �fNcl& &� EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 12 <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 <br /> ACCESS CASING SECURED <br /> 17 18 <br /> PIPING <br /> 19 20 <br /> INVENTORY RECONCILIATION 21 '' <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 <br /> 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD - <br /> 35 36 <br /> CONDITIONS ABATED37 -- ---- <br /> VA TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 j39 <br /> FLAMMABLE VAPORS REMOVED 40mF <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 [55 <br /> 47 <br /> PIPING 49 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 52 <br /> SAMPLING 54 <br /> IMPROPER ABANDONMENT 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) <br /> FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL. 0 VIOL.ED <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> HUT--3 ORIGINAL r- <br /> 5iaa ®� <br />