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UNDERGROU STANK PROGRAM OFFICIAL INS <br /> AN JOAQUIN HEALTH D STRICWION REPORT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME SChivt a PO95205 COUNTY # 3 <br /> PHONNEE NNO.O. 468-3423 <br /> SITE NAME: tree l- ?QY KI h S/rCL C e- INSPECTION DATE: <br /> SITE ADDRESS: 13 S` Sm He p` CITY/STATE/ZIP she-nl X009 p5a o S <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER , 33 NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION /f SITE COMPUTER# PER # PER # PER# PER # <br /> 1, EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TAN TANK coNreNrs <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 <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 --"- <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 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W444C5 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> 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 /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAJOR NO <br /> VIOL. ❑ VIOLL..R ❑ VOL F] <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> 1 <br /> HUT-3 ORIGINAL <br />