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UNDERGROUNir`TANK PROGRAM OFFICIAL INSPF^TION REPORT <br /> �.AN JOAOUIN HEALTH DISTRICT+ <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME PHONETNO. 468 3423 COUNTY # 3 <br /> SITE NAME: Pk, L -FM,,N S Op�S INSPECTION DATE:��-i'j�q 0 <br /> SITE ADDRESS: �G�j`7 7 S, pl4CITY/STATE/ZIP cf S�3 76 <br /> CH-ANGES SITE/OWNER/PERMIT? YES NO TANK ( TANK -L TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER o oa COMPUTE COMPUTE <br /> NUMBER10 0-00 NUMBER (0 NUMBER 000 NUMBER 5000 <br /> TYPE OF INSPECTION SITE COMPUTER# PER# /pt4f PER# Dl eSOI PER# 101 .�'�'� PER# <br /> 67 EXP.DATE EXP.DATE EXP.DATE P94 EXP.DATE 00 <br /> OPERATIONAL TANK TANK R I MINOR MAJOR MR <br /> R <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 <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 135 136 _ <br /> CONDITIONS ABATED VA 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445t <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 /> NIAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL ❑ VIOL❑ <br /> OFFICE: INSP:bLlx REC B <br /> TITLE: , PHON V ECK: <br /> r <br /> HUT-3 ORIGINAL 5/88 & <br />