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UNDERGROUI TANK PROOkAM OFFICIAL INSP' TION REPORT <br /> 'SAN JOAQUIN HEALTH DISTRICT`" <br /> 1601 E. HAZELTON AVE. <br /> couNrr NAME PH CKTON, CA 95205 <br /> NE NO. 468-3423 COUNTY # <br /> SITE NAME: <br /> INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK �- TAN 7- TANK R53 W� <br /> TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUT COMPUT � <br /> TY F INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> /� PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CowmE <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 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPUNG 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 4g qg -- <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 T <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 58 NO 9 <br /> VIOL LJ VIOL- ❑ VIOL <br /> F <br /> E: INSP: / RECEIVED BY: <br /> TITLE:C5yjA�j7?ge4jV4�-/ PHONE: I ECK: <br /> HUT-3 ORIGINAL siea O, <br />