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UNDERGROU TANK PROGRAM OFFICIAL INSPTION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMETPHONEKTON, CA 34205 23 COUNTY # <br /> SITE NAME: � / INSPECTION DATE: ��rJ•_�3 <br /> SITE ADDRESS: ILioCITY/STATE/ZIP �sC4�©✓! <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK -r TANK 3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> ©V'1•ch� I �l 6 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS / <br /> MAJOR MINOR ' (? '�o u, I., cod d)C-5 Ip Qm V.L <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE <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 19 120 �- <br /> INVENTORY RECONCILIATION 21 122 <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 W43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <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 MAR NE) FOLLOWS: / <br /> Ve//L <br /> MAJOR MINOR 58 NO 59 C r A <br /> VIOL. 57 VIOL 1:1 VIOL.❑ <br /> OFFICE: INSP-. RECEIVED BY: <br /> n <br /> TITLE: ,(/j� /� S ONE: RECK: <br /> JI IT-? - �/! nRIGINNAI 5/88 ©M <br />