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ANDERGRC)E:D", TANK PROGRAM OFFICIAL INSPF 7II0 4 RFP0RT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1,601 E. HAZELTON AVE <br /> STOCKCOUNTY NAME N, CA 95205 <br /> PHONE ONO. 468-3423 COUNTY # <br /> SITE NAME: ` / t o INSPECTION DATE, Ll_!�2 <br /> ;ITE ADDRESS: Z f� S CITY/STATE 5� 7C <br /> d <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> 'ORM A AND/OR B SUBMITTED? COMPUTE COMPUTER COMPUTER COMPUTER <br /> Y OF INSPECTION SITE COMPUTER# NUMBEVooD NUMBER NUMBER NUMBER <br /> �j PER # PER# PER # PER # <br /> IA���P/ /�� EXP.DA EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS } ', •..`t r .✓` f, yr <br /> OPERATIONAL TANK <br /> MAJOR MINOR <br /> OPERAT <br /> PERMIT TO OPERATE 1 2 <br /> ,CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> _._ ,...___._..._._.......__. ...._..__.__._-...---------_---- ___...__...............__.... ... __..__. <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 /> __.. ...._..--..-._-.__-_- __.._..__._ ... __.__—__..__.... -.---_' <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> 'ACCESS CASING SECURED 17 118 <br /> PIPING 19 20 <br /> I. <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 130 <br /> APPROVED TANK REPAIRS 31 32 <br /> _...................... _.. -..__.......__..,...._...-...... ......,......._.....__..__._ <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 136 <br /> CONDITIONS ABATED 37 <br /> Y :<' •�,rr• '?fi%v�iN S,4 .i<rt%'`%Fiq'P. .:'l'-' <.; <br /> TEMPORARY TANK CLOSURE <br /> wr <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED m 43 <br /> OWNER/OPERATOR MONITORING 44 45gr­ <br /> ..__ <br /> i ♦�1.�a�//, •../.: i-2�1- <br /> y� ' '� 'PERMANENT TANK CLOSURE ''?< a <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> ISAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 _ <br /> THE PIKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> ISYSTEM STATUS(MUST MARK ONE) FOLLOWS' <br /> 57 <br /> MAJOR MINVIOL VIOL.❑-- VOL_❑_ - _ <br /> OFFICE: INSPj .� RECEIVED BY: <br /> d r P —=� -- —� -- <br /> TITLE: p ,� � RECK: <br />