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UNDERGROUNrINNK PROGRAM OFFICIAL INSPEr 'ON REPORT <br /> sAN JOAOUIN HEALTH DISTRICL <br /> 1601 E. HAZELTON AVE. <br /> CA 525 <br /> COUNTY NAME JAtil P ONETNO. 46893423 COUNTY #3q <br /> INSPECTION DATE: <br /> SITE NAME: OGy �� Q I(p 8 <br /> SITE ADDRESS: I� til! CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK I TANK /// TANK TANK <br /> 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 <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 :i 34 <br /> SAFETY HAZARD35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL.OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <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 RE SENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 58 <br /> MAJOR 57 MINOR NO 59 <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP: F: � RECEIVED BY: <br /> TITLE: .E, N,rj, PHONE: RECK: <br /> HUT-3 ORIGINAL s/m ©M <br />