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UNDERGROWTANK PROGRAM OFFICIAL INSPr 'TION REPORT <br /> .. SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> CA 5205 <br /> COUNTY NAME PHONETNO. 4 893423 COUNTY # <br /> SITE NAME: /J. -rr INSPECTION DATE: 9_ <br /> SITE ADDRESS: Cis / CITY/STATE/ZIP �n <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK01 TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER OMPUTER COMPUTER COMPUTER <br /> NUMBER 0(J UMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# V I- PER# PER# PER# <br /> 7/- EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK R MI NOR <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 RECONCIUATION 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 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 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 8 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: AL �C - 401!(- <br /> �C2Y'czr cAX.nlo E-R <br /> MAJOR 57 MINOR 8 59 <br /> NO <br /> VIOL. ❑ VIOL ❑ VIOL <br /> OFFICE: INSP: /�J v RECEIVED BY: <br /> TITLE: t/ S PHONE: RECK: <br /> HLT-3 ORIGINAL 5/m OM <br />