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UNDERGROUND. TANK PROGRAM OFFICIAL INSPECTION REP <br /> SAN JOAQUIN HEALTH DISTRICT!001 E. 11AE66;4101 OW <br /> COU <br /> COUNTY NAME <br /> SITE NAME: S �(� L 45Z1 V INSPECTION DATE: <br /> SITE ADDRESS: v �� CITY/STATE/ZIP .{�Gt 7 <br /> CHANGES SITE/OWNER/PERMIT? Y TANK 01 TANK TANK TANF,C <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYP F INSPECTION 51TE COMP TER PER * PER PER # P6 / <br /> In e, EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> rnNx cor+lENis <br /> OPERATIONAL TANK M = - <br /> AJOR MINOR <br /> PERMIT TO OPERATE t 2 <br /> CHANGE IN CONDITIONS TO OPERATE ] 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 8 --- <br /> APPROVED MONITORING SYSTEM 9 10 __ ✓ - -• — <br /> MONITORING SYSTEM 1 1 12 —_ ----- <br /> APPROVED MONITOR FREQUENCY 13 14 ——___--- <br /> MONITORING RECORDS MAINTAINED 15 16 _ --- <br /> ACCESS CASING SECURED 17 18 — <br /> PIPING 19 -- <br /> INVENTORY RECONCILIATION 21 22 ✓ ETH -- <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 _ <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 _ <br /> SAMPLING 29 �5 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 _ <br /> SAFETY HAZARD 35 36 -- <br /> CONDITIONS ABATED 37 <br /> - ».� -_.`=� :'�Y' ice. :�= - ,•w-, -_, . <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 144 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 _�— <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED ! <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT SS 56 <br /> THE MARKED ITEMS REPRESENT VIOLLL ON AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:59 <br /> MAJOR 57 WNIOR Q NO <br /> VIOL VIOL VIOL <br /> OFFICE: INS � C� �p,�ifi RECEIVED ABY':, <br /> TITLE: PHONE: RECK: <br /> HUT-3 *-w0RIGINAL <br /> 1 . <br />