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UNDERGROUN NK PROGRAM OFFICIAL INSPE ON REPORT <br /> 40 WN JOAQUIN HEALTH DISTRICT f <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME OO. 46 8-3423 95205 <br /> PHONNEE NNO. 46COUNTY # <br /> P <br /> SITE NAME: Qu,1G Ify -sAINSPECTION DATE: 6--Z J-Sg <br /> SITE ADDRESS: :2,d �7--7 Sr , L oD1jRA-pOCITY/STATE/ZIP .5-rkW C4�- <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK ' TANK TANKTANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPU R COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYKE OF INSPECTION v f SITE COto MPUTER# PER <br /> DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK C NTENTS <br /> MAJOR MINOR " <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 �A A <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 110 " <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 19 20 <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 33 34 ~~- <br /> SAFETY HAZARD 35 136 �� <br /> CONDITIONS ABATED 37 M _._- <br /> _ <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED mm 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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 REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: Z O /-' Z <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP:ly RECE ED BY: <br /> TITLE: Rs C . <br /> HUT-3 ORIGINAL 5/88 0M <br />