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UNDERGROUNn TAIk'K PROGRAM OFFICIAL INSPECTIr-A-1 REPORT <br /> �*OAQUIN HEALTH DISTRICT <br /> � � ITl <br /> 'hue/, 1601 E. HAZELTON AVE. �1 <br /> FCOUNTYE STOCKTOO. 46 -3423 COUNTY #�? <br /> PHONE NO. 468-3423 <br /> SITE NAME: r-- G INSPECTION DATE:/Z <br /> SITE ADDRESS: / CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO I TANK / TAW TANK l TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TY E pF I PECTI SITE COMPUTER# NUMBEF�� (�(jC1 NUMBER NUMBER NUMBER <br /> ?TZ �� � PER# � C� PER # PER# PER # <br /> VAf EXP.DAT CY5 EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS iA/�41A <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 9 110 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREOUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 T <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 35 136 <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 CORRECTEq AS <br /> SYSTEM STATUS[MUST MARKONEy FOLLOWS: /v/ h <br /> MAJOR 57 MINOR 58 NO 5 iv"� <br /> VIOL. ❑ VIOL. ❑ _ VIOL. <br /> iL <br /> ✓ '✓� S� -----� <br /> OFFICE: INSy RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> WT-3 OPlu;t;r'_ 5 =P DN <br />