Laserfiche WebLink
UNDERGROUI"^ TANK PROGRAM OFFICIAL INSPF^TION REPORT <br /> %,,3AN JOAQUIN HEALTH DISTRICT <br /> N9Fl1 E. II OE .� <br /> COUNTY NAME ai*QN,-QA-Qa2Q5COUNTY # 3 <br /> SITE NAME: l 5 Ow I v 41 v Lc—,e J INSPECTION DATE: <br /> SITE ADDRESS 1007 % 6— �p� CITY/STATE/ZIP �L�,,, �J <br /> CHANGES SITE/OWNER/PERMIT? Y T/ANKH O I TANK D TANK �, �'` \ TANK <br /> FORM A AND/OR B SUBMITTED? IU COMPUTER COMPUTER COMPUTER CO LITER <br /> NUMBER NUMBER NUMBER NU BER <br /> TYP F I ffCnO� S�EDCOMPSJ,TER# PER# PER# PER# <br /> PXR# <br /> EXP.DATE EXP.DATE EXP.DATE P.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 78 � / <br /> APPROVED MONITORING SYSTEM 9 10 ✓ V <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 v 16 <br /> ACCESS CASING SECURED 17 18 _ <br /> PIPING 19 20 y _ <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 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 _ <br /> POWER DISCONNECTED ME 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 M <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATION9 AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 58 <br /> MAJOR57 MINOR NO <br /> VIOL. VIOL LJ VIOL.I <br /> OFFICE: INS : " l01 RECEIVED BY: <br /> TITLE: 1& PHONE: RECK: <br /> HUT-3 ORIGINAL / ei� <br />