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UNDERGROUWK PROGRAM OFFICIALIIINSP VN REPORT <br /> JOAQUIN HEALTH DISTRICl� <br /> 1601 E. HAZELTON AVE ?! ( - - q- <br /> 95205 <br /> COUNTY NAME STocKrNO. 468-3423 <br /> 6 -3423 COUNTY # 3 1 <br /> e : PHONE NO. 468 3423 <br /> SITE NAME: ' � ' (I� 6tI Cie f INSPECTION DATE; <br /> SITE ADDRESS: TY/STATE/ZIP <br /> `� 1 I ( � 1&5 l,00 �5 T 9S3r16 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK /y� TANK'+ TANK TANK <br /> -. FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER - - COMPUTER <br /> TYPE OF INSPECTION - SITE COMPUTER# NUMBER I pAVS-AD NUMBER. NUMBER NUMBER <br /> .. PER#k� PER#,�I _ PER# PER# <br /> 53 - EXP.DATE - EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANKTANK CONTENTS <br /> MAJOR MINOR _PERMIT TO TO OPERATE w _ - - -- 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 - <br /> APPROVED CONSTRUCTION -' 5 6 iV <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 - - - <br /> MONITORING SYSTEM - 11 1 - - - - <br /> -APPROVED MONITOR FREQUENCY 13 4 - - - - -- <br /> MONITORING RECORDS MAINTAINED` 15 16 --'•.i <br /> ACCESS CASING SECURED - 17" 18 - <br /> _PIPING 19 20 . <br /> INVENTORY RECONCIIJATION 21 R2 - - - - <br /> - TANK GAUGING - , : . '- - 23 24 if - <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 /> Irk• CONDITIONS ABATED <br /> 'i <br /> TEMPORARY TANK CLOSURE . }` <br /> REMOVAL OF RESIDUAL38 39 <br /> FLAMMABLE VAPORS REMOVED <br /> W47 <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTEDOWNER/OPERATOR MONITORING - . . .. • ' - . <br /> -.... .. <br /> 3 „ <br /> PERMANENT TANK"CLOSURE <br /> ,. ,REMOVAL-OF RESIDUAL MATERIALS - 48 147 <br /> .:FLAMMABLE VAPORSREMOVEDUNAUTHORIZED RELEASE 52 - - - <br /> SAMPUNG <br /> :. 53 54 _;. sr -- - <br /> I, <br /> IMPROPER ABANDONMENT �:::._ .:�.. 55 56 - -... , .... - ' .... <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE RRECTED AS - <br /> SYSTEM STATUS(MUST MARKONE) - - <br /> ,._'' . � FOLLOWS: � tag <br /> 1' <br /> MAJOR [yT MINOR-� NO- ''� <br /> VOL VAI YIOL% VIOL <br /> .. OFFICE:. fINSP: D ECEIVE - <br /> yt <br /> �� 143 / TITLE "�F�—�s PHONE RECK <br /> S143 <br /> O <br /> HUT-3 ORIGINAL <br /> siae: <br />