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UNDERGROU*TANK PROGRAM OFFICIAL INSP'TION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> CA 205 <br /> COUNTY NAME PHONETNO. 468-3423 COUNTY # <br /> SITE NAME: 15 J INSPECTION DATE:,�_ d-F_ V3 <br /> SITE ADDRESS: n CITY/STATE/ZIP GS�ila� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK 2 TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTE COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # PER # PER # PER # <br /> lGW - L/o S EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CCNTeNTS <br /> MAJOR MINOR (,� �� 4- � oev <br /> PERMIT TO OPERATE <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM <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 19 120 1 ✓ - 7/ _�i/ _ _ ,__...... <br /> INVENTORY RECONCILIATION _ 21 122 1 ✓ ✓ _ <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 36 .. <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 .. _. <br /> POWER DISCONNECTED 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' <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL ❑ VIOL.❑ rI stir <br /> OFFICE: INS ! � RECEIVED BY. <br /> TITLE: PHONE: PECK: <br /> 5/88 <br />