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UNDERGR_Q ''yrs TANK PROGRAM OFFICIAL INF' ^TION REPORT <br /> SAN JOAQUIN HEALTH DISTR16id <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME P ONE ONO. 46$ 3423 COUNTY # <br /> SIFE NAME: INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> C� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK r TANK TANK TANK C f <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER " COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> i <br /> PER# PER# PER#, PER# <br /> EXP DATE EXP.DATE EXP.DATE <br /> EXP.DATE <br /> OPERATIONAL TANK TANK cor+reNTs K <br /> MAJORI MINOR <br /> PERMIT TO OPERATE 1 12 ` <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 RECONCIUAi10N 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 CLOSUREqg% 'Are 'Qil WE <br /> � I-OR <br /> REMOVAL OF RESIDUAL38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> } f <br /> PERMANENT TANK CLOSURE r ' <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING r <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 NO 59 <br /> VIOL ❑ VIOL ❑ VIOL❑ <br /> OFFICE: INSP0" <br /> RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> HUT-3 ORIGINAL area O <br />