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UNDERQROI IND TANK PROGRAM OFFICIAL INSr ACTION REPORT <br /> ,4 SAN JOAQUIN HEALTH DISTRICT,, <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME SHO KTON,E NO. CA 520 COUNTY # <br /> SITE NAME: INSPECTION DATE: -;/,-/9/Y? <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> vp �b <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTCR <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> - PER# PER# PER# PER# <br /> /5-3—-3 J EXP.DATE EXP.DATE EXP.DATE EXP.DAT <br /> OPERATIONAL TANK TANK CONTEI <br /> MAJOR MINOR e - <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 <br /> APPROVED MONITORING SYSTEM 9 10 _. a0 <br /> UV <br /> MONITORING SYSTEM 11 ��� u SIt O' <br /> APPROVED MONITOR FREQUENCY 13 14 l / . / Q f�.(� <br /> MONITORING RECORDS MAINTAINED 15 16 V GI'"- <br /> ACCESS CASING SECURED 17 <br /> PIPING 1g 2p <br /> INVENTORY RECONCILIATION 21 2 <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 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 /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: /`C <br /> 6 <br /> MAJOR MINOR NO 59 <br /> VIOL 57 VIOL. ElVIOL❑ <br /> OFFICE: INSP: L Gc/ RECEIVED BY: <br /> �— 'L <br /> TITLE: 7` ` PHONE: BECK: <br /> HUT-3 ORIGINAL Sim OM <br />