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UNDERGROUNQWNK PROGRAM OFFICIAL INSPE ON REPORT <br /> N JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> FYNAME <br /> PHo PHONE 4 8-3423 CA 95205 COUNTY # <br /> SITE NAME: 66U 'US. INSPECTION DATE <br /> SITE ADDRESS: �Jb� �vh/�f CITY/STATE/ZIP f CJS-?7 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK I TANK TANK V yE TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTEpR`yy.�ti�7 COMPUTER 51 COMPUTER <br /> TYP yNUM <br /> OF I SPE_CTION SITE COMPUTER Q# PER #NUMBp tg'o f PER## ER7 x U PER BE M PER B <br /> ER <br /> (��(/✓'e'e ! 6 0 EXP.DATE 1 EXP.DATE tl EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TAN OR MIN TR <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 ------ ---- --- - -- - - <br /> CHI�GE IN CONDITIONS TO OPERATE 3 4 <br /> APPRIIOVED 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 ._--- <br /> SAFETY HAZARD <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATORMONITORING 44 45 <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 STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP:G/ RECEIVED B <br /> r <br /> TITLE: � s PHONE: fRECK: <br /> HUT-3 ORIGINAL alae <br />