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UNDERGROUNr TANK PROGRAM OFFICIAL INSPE`ION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT lv! <br /> 1601 E. HAZELTON AVE. <br /> CA <br /> COUNTY NAME PHONETNO. 468-34203 COUNTY # <br /> SITE NAME: �� �fe�p sr INSPECTION DATE: /y <br /> SITE ADDRESS: 2 9Z9 J `�/�/t q CITY/STATE/ZIP S'ToGL«j� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK f TANK , TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> 6 EXP DATE EXP DATE EXP DATE EXP DATE <br /> OPERATIONAL TANK NKNOR <br /> MAJORR MMINOR <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 1 <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 2 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 M37 <br /> SAFETY HAZARD CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED 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 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 2-' O Z <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL. ❑ VIOL❑ <br /> OFFICE: INSP: / RECEIVED BY: <br /> TITLE: �f PHONE: UN RECK: <br /> •.-IUT-3 ORIGINAL 5/M OM. <br />