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UNDERGROUN" TANK PROGRAM OFFICIAL INSPF-TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> - 1601 E. HAZELTON AVE. <br /> COUNTY DAME SSTOCK , CAa.W PHONETONNO. 4683423 COUNTY # 3Cf <br /> INSPECTION DATE: <br /> SITE NAME: �u G K I <br /> I SITE ADDRESS: /1 7� c K <br /> CITY/STATE/ZIP J /� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK 05 TANK 0� TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTE COMPUTER COMPUTER <br />'INUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COffM__PUTERR# PER# PER# PER# PER# ' <br /> L!/ ✓ EXP DATE EXP DATE EXP DATE EXP DATE <br /> OPERATIONAL TANK TANK CONTENTS , dP :s s <br /> MAJOR MINOR ,�, c _k 2 ,F _. ..; : P „ <br /> 00 <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 /> i MONITORING SYSTEM 11 112 <br /> f APPROVED MONITOR FREQUENCY 13 114 <br /> MONITORING RECORDS MAINTAINED 15 116 <br />} ACCESS CASING SECURED 17 18 ---- <br />{ PIPING 19 120 �_ _ <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 31 132 <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD 35 13r, <br /> I <br /> CONDITIONS ABATED 37 <br /> I x a <br /> :gyp` ass <br /> TEMPORARY TANK CLOSURE �� 8 ' > b <br /> A.. ,< ° <br /> .Rs & Sdva`s..�. S # '. aA°x�. x*s. .ne..Y«^d4.•...Aa.,.... . <br /> REMOVAL OF RESIDUAL 39 _ <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 42 . � <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44645 <br /> A m <br /> PERMANENT TANK CLOSURE � " <br /> REMOVAL OF RESIDUAL MATERIALS 46 147 <br /> PIPING 4 449 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) <br /> FOLLOWS: <br /> 57 58 59 <br /> MAJOR NO VIOL, ❑ VIOLL..R ❑ VOL.❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> I <br /> TITLE: PHONE: BECK: <br /> HUT-3 FILE COPY 6188 0M <br />