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UNDERGROUN,',ITANK PROGRAM OFFICIAL INSPF'�TION REPORT <br /> ( ,AN JOAQUIN HEALTH DISTRICT ) P <br /> V 1601 E. HAZELTON AVE. `+� <br /> 1i1NTY NAME PHONE TON, CA 95205 <br /> NO. 468-3423 COUNTY # <br /> SITE NAME. �rn IeD VA <br /> ��j� Z 70? fNSPECTION DATE: 2 �Q <br /> SITE ADDRESS: CITY/5&E <br /> CHANGES SITE/OWNER/PERMIT? YES vNO TANK TANK J7 ! TANK f� <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER NUMBER NUMBER NUMBER NUMBER <br /> �,I� I I PER# = PER# PER # . PER# <br /> V ! EXP.DATE' EXP.DATE EXP.DATE 'EXP.DATE <br /> 14 <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 119 120 <br /> INVENTORY RECONCILIATION W13 <br /> - <br /> TANK GAUGING <br /> APPROVED RESPONSE PLAN - - <br /> UNAUTHORIZED RELEASE OCCURRENCE <br /> SAMPLING <br /> APPROVED TANK REPAIRS <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD 35 136 <br /> CONDITIONS ABATED 37 -- - <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 138 139 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED --�- <br /> OWNER/OPERATOR MONITORING 44 145 <br /> PERMANENT TANK CLOSURE "' ` � � :"� �" �' <br /> �*�"^4T91.r� a + � •.� �r� h �yfiU•, Ax - _":.;. S <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 REPRESENT VIOLATIONS AND MUST SE'CORRECTED AS, , <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:'' <br /> MAJOR 57 MINOR NO 58 9 t <br /> VIOL LJViOL. ❑ VIOL <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE.//2 l.e-- 1/ PHONE: BECK: <br /> HUT-3 ORIGINAL 0M <br />