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U,�ERGROUND TANK OFFICIAL INSPECTION 11 '4RT <br /> SAN JOAGUMI PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> 115 N.Son J*kiwn$"* <br /> OCLMoog <br /> Adds P.O.Box 388 <br /> 1-0388 #� <br /> ITY) <br /> TE NAME: a. ' ` - ,� INSPECTION DATE: 7 Q <br /> TE ADDRESS: 4Pg A Jr <LG�(? s y CITY/STATE/ZIP sib <br /> ANGES SITE/OWNER/PERMff? YES NO TANK,.• K G <br /> RM A AND/OR B SUBMITTED? TANK TANK <br /> TANK <br /> ITER COMPUTER COtu�UTER COMPUTER <br /> PE OF INSPLEC�TII,O,N�/Q Q -SITE COMp�R# NUMBER NUMBER NUMBER NUMBER <br /> �Ji��� EXP.DATE EXP.DATE PER# PER <br /> OPERATIONAL TANKs <br /> EXP.DATE EXP.DATE <br /> w�c co�nrs <br /> MAJOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION5 6 <br /> WRITTEN MONITORING PROCEDURES 7 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MOMTORINGSYSTEM <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECONS MAIMAINED 15 16 <br /> ACCESS CASING SECURED 17 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION21 22 <br /> _.__... _..__.. <br /> TANK GAUGING 23 24 <br /> D RESPONSE PLAN 25 28 _..._.. ..__.... . .... ......... <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 ABATED37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL U3111FLAMMABLE VAPORS REMOVEDACCESS LOCATIONS SEALEDPOWER DISCONNECTED <br /> _.. _._._ <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE 'r <br /> 4 <br /> REMOVAL OF RESIDUAL MATERIALS 46 147 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50im <br /> f <br /> UNAUTHORIZED RELEASE 51 52 w <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 58 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:—.&<.A, <br /> 57 58 59 <br /> VIOL ❑ MINOR NO <br /> VIOL. ❑ VIOL❑ i <br /> OFFICE: INSP ' RECEIVED BY: <br /> 14d <br /> TITLE: r • PHONE: BECK: <br />