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UNDERGROU ' TANK PROGRAM OFFICIAL INSF' 'TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC"k <br /> 1601 E . HAZELTON AVE. <br /> COUNTY NAME PHONE NO. 8CA 93423 5205 COUNTY # , � J <br /> SITE NAME: k) , n) F ot/j q 1 � / �C INSPECTION DATE: j <br /> SITE ADDRESS: �eJ� CITY/STATE/ZIP C % ' <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK .J TANK 6 3 TANK <br /> j FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER # PER # PER # PER # PER # <br /> EXP. DATE EXP. DATE EXP. DATE EXP. DATE <br /> OPERATIONAL TANK TANK CONTENTS <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 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 35 36 <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 CORRECTED AS <br /> SYSTEM STATUS (MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 59 <br /> NO <br /> VIOL ❑ VIOL. LJ VIOL. ❑ <br /> OFFICE: INSP: RECEIVED BY;`�-� 1 <br /> TITLE: �'� L/ cJHE: BECK: <br /> HUT-3 ! FILE COPY area DN <br />