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UNDERGROUt TANK PROGRAM OFFICIAL INSP' <br />USAN JOAQUIN HEALTH DISTRICT <br />/ 1601 E. HAZELTON AVESTOCK. <br />205 <br />COY NAME 5q,;l V B PHONETNO 468 CA 3 <br />COUNTY 423 <br />TION REPORT <br />COUNTY # 3 9 <br />SITE NAME: <br />TE:/ <br />AA <br />IINSPECTIONDATE: <br />SITE ADDRESS: / Z� <br />P <br />�,)�2 ali®j <br />CITY/STATE/ZIP,5//C,' t/ C tl S,:� 0(--^ <br />7 <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />ANKTANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />OMPUT <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />MBER <br />P R# / � e' <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />TYPE OFF,INSPECTION <br />SITE COMPUTER # <br />I-Y/vV✓v v a --e- <br />/ <br />E DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CON NTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 _ <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 _ <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />_ <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />F37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W43 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 1% <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />MAJOR 57 58 MINOR NO <br />9 <br />- - <br />11 <br />VIOL. VIOL. VIOL. <br />OFFICE: <br />IN P: <br />RECEIVED BY: <br />TITLE: <br />PHONE: <br />BECK: <br />HUT' -3 ORIGINAL 5/88 O' <br />