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UNDERGROU' TANK PROGRAweOFFICIAL INSP" 'TION REPORT -,.,AN JOAQUIN HEALTH DISTRICT, 1601 E. HAZELTON AVE. CA 95205 COUNTY NAME P ONETNO. 468-3423 COUNTY # SITE NAME: Tie E Cw INSPECTION DATE: �0�28 SITE ADDRESS: /4/' 0 S, 'Soldly CITY/STATE/ZIP G CHANGES SITE/OWNER//PEERMIT? YES NO TANK ' TANK TANK TANK FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER / COMPUTER NUMBER NUMBER NUMBER/,`/'� J NUMBER TYPE OF INSPECTION SITE COMPUTER# PER# Q•Y��I PER# PER# yv�1/ PER # 7�E/ EXP.DA EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK R M I N R MAJOR MINOR PERMIT TO OPERATE 1 2 - CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 10 _ MONITORING SYSTEM 11 12 _.. APPROVED MONITOR FREQUENCY /3 14 _ MONITORING RECORDS MAINTAINED 15 116 ACCESS CASING SECURED 17 118 1 PIPING 19 20 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 _ UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 _ UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 136 _ CONDITIONS ABATED VZZ, 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 _ FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 142 POWER DISCONNECTED 43 _ OWNER/OPERATOR MONITORING 44 145 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 _ SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS�AND MUST BE COR9ECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS:58 """"� d✓ MAJOR 57 MINOR NO 59 � VIOL VIOL ❑ VIOL❑ OFFICE: jlNSP- RECEIVED BY: PHONE: BECK: HUT-3 ORIGINAL sine n