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WAN JOAQUIN HEALTH DISTRICT ���V rs�rvrta <br /> COUNTY DAME <br /> 1601 E. <br /> CA095205 <br /> PHONE NO. 468-3423 COUNTY # 3� <br /> SITE NAME: <br /> / . S INSPECTION DATE: I <br /> SITE ADDRESS: r 700 5 Lr� CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? 5 � C4 <br /> S NO TANK / TANK ,Z TANK 3 TANK Y <br /> FORM A AND/OR B SUBMITTED?_%t, c COMPUTER COMPUTER COMPUTERCOM <br /> $ 1 <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER COMPUTE <br /> NUMBER NUMBER <br /> PER# PER# PER# PER # <br /> EXP.DATE EXP. EXP DATE <br /> DATE { <br /> OPERATIONAL TANK TANK COMMrrrs � -�� ,�� ,� . .f .•, � � � EXP DATE <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 I <br /> APPROVED CONSTRUCTION 5 6 — _ <br /> WRITTEN MONITORING PROCEDURES <br /> APPROVED MONITORING SYSTEM g 10 — <br /> MONITORING SYSTEM <br /> 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 .35 36 - —--- _ <br /> CONDITIONS ABATED 37 <br /> } <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 /> rk ' <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 �•fJ " �/J <br /> UNAUTHORIZED RELEASE 51 52 !�- <br /> SAMPLING9 l <br /> 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: gNks ! 2 3 y f rlelw-W / fibs da74 <br /> 57 58 59 /mss ,N y Clostvv__ <br /> MAJOR ❑ MINOR ❑ NO 5 G 5 <br /> VIOL VIOL VIOL <br /> OFFICE: INSP:��f mfr RECEIVED BY: <br /> i. I �yVf <br /> TITLE: �� 5 PHONE: <br /> BECK: <br /> HUT-3 ORIGINAL <br /> s;aa ®M <br /> I <br />