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UNDERGROUND TANK PROGRAM OFFICIAL INSPF"TION REPORT <br /> _ SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE.CA 95205 <br /> - <br /> COUNTY NAME PHONETNO. 468-3423 COUNTY # <br /> SITE NAME: �j o� INSPECTION DATE: <br /> SITE ADDRESS: _O SZJ S. ca CITY/STATE/ZIP K <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK AN <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER NUMBER al �( <br /> NUMBER M NUMBER NUMBER �j I NUMBER �I <br /> TYPE OF INSPECTION SITE COMPUTER# p PER# ft-o// PER# 17?/-(55 PER# 17 0 -0k PER# I <br /> leoGt�"/�„e 70/ 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 0 J UJ /w 0 <br /> MONITORING SYSTEM 11 12 Y / <br /> e ��- <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 _ L✓Y _ I� <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 _ ,�J' <br /> INVENTORY RECONCILIATION 21 22 7&t,V <br /> TANK GAUGING 23 24 I / �L <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 t 6+/" <br /> APPROVED TANK REPAIRS 31 32 W - <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> I <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 11 L <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 _ <br /> SAMPI 53 5 _ <br /> ROPERABAN NMENT 55 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MD RK ONE FQLLOWS: tSrlAQ %o) A0POLeSS_ Q 1v3�j. <br /> Place, <br /> MAJOR 51 h <br /> MINOR 58 NO 59 g �f ' J Az&ol WA kQln <br /> VIOL. VIOL. VIOL❑ ✓ - <br /> Le <br /> OFFICE: INSP: BY:RECEIVED <br /> C/ AA- <br /> TITLE: �Q G �. S/ PHONE: RECK: <br /> HUT-3 ORIGINAL <br />