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UNDERGROU SAN�PROGRAM OFFICIL OAQUIN HEALTH DISTR CT�T10N REPO � <br /> 1601 E. HAZELTON AVE. COUNTY '#,3j <br /> I <br /> T ONETON, CA NO. 46895205 <br /> 3423 <br /> COUNTY NAME INSPECTION DATE: 77/" <br /> SITE NAME: <br /> CITY/STATE/ZIP <br /> SITE ADDRESS: TANK TANK <br /> N ANK / TANK COMPUTER COMPUTER <br /> CHANGES SITE/OWNER/PERMIT? Y ppMPUTER COMPUTER NUMBER NUMBER <br /> NUMBER NUMBER PER# <br /> FORM A AND/ B SUBMITTED? PER# PER# <br /> SITE COMP R# PER# EXP.DATE EXP. TE <br /> TY OF INSPECTION EXP.DATE <br /> D EXP.DATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK MAJoR MINOR <br /> PERMIT TO OPERATE -- <br /> CHANGE IN CONDITIONS TO OPERATE <br /> APPROVED CONSTRUCTION -- <br /> WRITTEN MONITORING PROCEDURES <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 :n 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 139 1- <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 142 <br /> POWER DISCONNECTED 43 <br /> 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 s <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATION AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: `Jt <br /> MAJOR 57 MINOR 58 NO 5599�/ <br /> VIOL ElVIOL. ❑ VIOL.LI <br /> 17 <br /> OFFICE-• _� INSP: �/ � RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> HUT-3 ORIGINAL siee ©M <br />