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UNDERGROUTAANK PROGRAM OFFICIAL INSP ION REPORT <br />SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />CTn(-v Tf)N rA argnF, nnuury ie A/] <br />GUUIVII mAmt ��'� �� �irz <br />PHONE NO. 468-3423 <br />uuun� .77 <br />SITE NAME: sat) `771GY9" n <br />.�.,y <br />�' 7 "H �u� <br />�'d <br />INSPECTION DATE: /-j I?- fo <br />SITE ADDRESS: 19/0 6. Ma3ulm <br />ACCESS LOCATIONS SEALED <br />CITY/STATE/ZIP <br />SfOCIf�OX /M Q 20/ <br />CHANGES SITE/OWNER/PERMIT? <br />YES NO <br />TANK�"j <br />TANK <br />TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTE-' <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER COMPUTER <br />NUMBER NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # <br />o uWnt 141 <br />PER # <br />EXP. DATE <br />PER # <br />EXP. DATE <br />PER # PER # <br />EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />r.. ._..__.._, <br />IMPROPER ABANDONMENT <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />58 <br />MAJOR 57 MINOR <br />❑ <br />59 <br />NO <br />❑ <br />APPROVED MONITORING SYSTEM 9 10 M <br />MONITORING SYSTEM <br />11 12 <br />VIOL. <br />APPROVED MONITOR FREQUENCY <br />13x 14 <br />.Y <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED 17 18 <br />PIPING <br />19 20 <br />.oEeB E& <br />n*-�-�-T�*--�'�: <br />--R i :hard <br />W ' <br />n"n c <br />INVENTORY RECONCILIATION <br />21 22 <br />grzC.4 9520 <br />TITLE: 644-S. <br />TANK GAUGING <br />23 24 <br />BECK: <br />APPROVED RESPONSE PLAN 25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />- <br />SAMPLING 29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />mm <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />47 <br />PIPING <br />49 <br />FLAMMABLE VAPORS REMOVED <br />r53 <br />UNAUTHORIZED RELEASE <br />52 <br />SAMPLING <br />54 <br />r.. ._..__.._, <br />IMPROPER ABANDONMENT <br />55 156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS <br />AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />e� <br />58 <br />MAJOR 57 MINOR <br />❑ <br />59 <br />NO <br />❑ <br />VIOL. VIOL. <br />VIOL. <br />OFFICE: <br />INSP: <br />�t`InGIYQ. <br />1pa pa4" anr)5 <br />.oEeB E& <br />n*-�-�-T�*--�'�: <br />--R i :hard <br />W ' <br />n"n c <br />P.O. Qow <br />grzC.4 9520 <br />TITLE: 644-S. <br />PHONE: <br />BECK: <br />' HUT -3 ORIGINAL 5/88 (9 <br />