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UNDERGROUNQ TANK PROGRAM OFFICIAL INSPEWN REPORT N JOAQUIN HEALTH DISTRICT 1601 E. HAZELTON AVE. COUNTY NAME PHo PHONE 4CA 8 3423 COUNTY # NAME: C0 LR dTQ A K IC C INSPECTION DATE: SITE ADDRESS: t) 41 L I ,j CITY/STATE/ZIP —rg fa } �S 37 CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER NUMBER �.�n, � NUMBER SU NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# v 3 " PER# PER # PER# PER# S EXP.DATE°'�Z"- EXP.DATE P-d EXP DATE EXP DATE OPERATIONAL TANK - TANK CONTENTS i ,,4 . XP. MAJOR MINOR � PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 - APPROVED CONSTRUCTION 5 6 - - WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 10 MONITORING SYSTEM 11 12 APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 - PIPING 19 20 _ INVENTORY RECONCILIATION 21 22 - TANK GAUGING - 2S P4 _ APPROVED RESPONSE PLAN 25 126 - UNAUTHORIZED RELEASE OCCURRENCE 27 128 -- SAMPLING P9 30 ``APPROVED TANK REPAIRS 31 32 UTHORIZED RELEASES REPORTED 33 34 FETY HAZARD35 36 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 3g m,45 FLAMMABLE VAPORS REMOVED 40 7777 ACCESS LOCATIONS SEALED 41 POWER DISCONNECTED OWNER/OPERATOR MONITORING 44 PERMANENT TANK CLOSURE a' REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 - - UNAUTHORIZED RELEASE 51 52 SAMPLING 8 54 -7 IMPROPER ABANDONMENT 55 56 -777,1 - THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 1 0 F 4n 57 58 59 VIOL MINOR NO IO FKI VIOL ❑ VOL❑ S /J a 04 1 rFICE: INS P RECEIVED BY: 3�r{ f%A N N, TITLE:it F PHONE: RECK: HUT-3 FILE COPY 5/m OM