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UNDERGROUTANK PROGRAM OFFICIAL INSPWION REPORT SAN JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. CA 205 COUNTY NAME PHONETNO. 468-3423 COUNTY # 3 Cf SITE NAME: INSPECTION DATE: SITE ADDRESS: CITY/STATE/ZIP / c 7 5 '�dS CHANGES SITE/OWNER/PERMIT? YES NO TANK 0 / TANK 6) TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBERNUMBER NUMBER NUMBER TYPE OF IINSPECTIO�N� y/1 SITE COMPUTER# PER # /5 75 PER# ° 715- PER # PER# -r/ly?/�Y 76 EXP.DATE EXP.DATE EXP.DATE EXP.DATE IANOPERATIONAL TANK P1516 MINOR MINOR PERMIT TO OPERATE 2 CHANGE IN CONDITIONS TO OPERATE 4 _ APPROVED CONSTRUCTION 6 WRITTEN MONITORING PROCEDURES 8 ... APPROVED MONITORING SYSTEM 10 MONITORING SYSTEM 12 (,�__.-. _ APPROVED MONITOR FREQUENCY 14 _.... MONITORING RECORDS MAINTAINED w ACCESS CASING SECURED 17 18 PIPING 19 20 .p1 �1,! _ 42444, INVENTORY RECONCILIATION 21 22 _ TANK GAUGING 73--24 -- APPROVED 324 __APPROVED RESPONSE PLAN 25 26 i UNAUTHORIZED RELEASE OCCURRENCE 27 128 SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL W4142 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED _POWER DISCONNECTED OWNER/OPERATOR MONITORING PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT i56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS:MIN 57 58 59 NO VIOL. ❑ VIOLR ❑ VOL.❑ OFFICE: INSP:� ^ _ RECEIVED BY: P'A'. . Imo" TITLE: f4>�1 PHONE: RECK: HIIT-A 44 4 1 FILE COPY 5 ©m