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UNDERGROU! TANK PROGRAM OFFICIAL INSP`'TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT.,,� <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME PHo <br /> PHONE 4689CA 3423 COUNTY # <br /> SITE NAME: Oca INSPECTION DATE: <br /> SITE ADDRESS: 10 Aor- '.:pt ! CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO ANK / TANK —2, TANK TANK tr/ <br /> FORM A AND/OR B SUBMITTED? COMPUTER / COMPUTE COMPUTER COMPUTER <br /> NUMBER v I NUMBER ��1)'11 ' NUMBER NUMBER uJ. <br /> TYPE OF INSPECTION SITE COMPUTER# PER# /d 00D PER# jj%QO 0 PER#Aj d � PER# (� <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CON NTS <br /> MAJO INOR <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 HAZARD35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 36 39 _ <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 41 42 _ <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 145 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM S/MINOR <br /> T MARK ONE) FOLLOWS: <br /> MAJOR 58 N59 <br /> VIOL. VIOL. ❑ VIOL❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> LE: PHONE: r'✓ H BECK: <br /> 3s�- 90o <br /> HUT-3 ORIGINAL 5;736 q8o o a.ea Ci <br />