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UNDERGROUP TANK PROGRAM OFFICIAL INSPF TION REPORT <br /> β€”AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME PHONETNO. CA 468 3423 95205 COUNTY # <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: y g ? S CITY/STATE/ZIP <br /> Corfu/ loc.' <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK ^ TAmk TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTERd COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER 171 Q NUMBER NUMBER NUMBER <br /> PER# PER# PER# PER# <br /> OPERATIONAL TANK MNK coNrell <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> Ai <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 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 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 50mm <br /> UNAUTHORIZED RELEASE 51 52 <br /> MP N 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLL0WS: <br /> 57 58 59 <br /> MIN <br /> 'VLl LlVIOOR ❑ VOL.❑ <br /> OFFICE: INS P: RECEIVED BY: <br /> Ya/ Z d- <br /> TiV /PPrG A- <br /> TITLE: Flys PHONE: HECK: <br /> HUT-3 ORIGINAL <br />