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UNDERGROIND TANK PROGRAM OFFICIAL INOCTION REPORT <br /> SAN JOAQUIN HEALTH DISTRI <br /> 1601 E. HAZELTON AVE. <br /> COUNTY HANE PHONO. 4CA 6 3423 COUNTY # <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: /p )/ f CITY/STATE/ZIP <br /> CHANGES SITE/OWNERI/PERMIT? YES NO T K / TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> ITY�P�EO�F INSPECTION SITE COMPUTER # NUMBER / 000 NUMBER NUMBER NUMBER <br /> PER# rf PER# PER# PER# <br /> EXP.DATE�� EXP.DATE EXP DATE EXP.DATE <br /> OPERATIONAL AN TANK CONTENTS <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 RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25j <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 <br /> SAMPLING 29 <br /> APPROVED TANK REPAIRS 31UNAUTHORIZED RELEASES REPORTED 33SAFETY HAZARD 35CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL M4445 <br /> FLAMMABLE VAPORS REMOVED - -- <br /> ACCESS LOCATIONS SEALED ti-POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS rl <br /> 47 <br /> PIPING 49 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE <br /> 52 q)pq <br /> SAMPLING 54la —_ <br /> IMPROPER ABANDONMENT 56 <br /> SYSTEM STATUS(MUST MARK ONEy —.-.- <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> FOLLOWS: <br /> 57 58 59 <br /> MAJOR MIN <br /> No <br /> VIOL. VIOL R VOL.D <br /> OFFICE: INSP: RECEIVED BY: <br /> ,TIT PHONE: BECK: <br /> HUT-3 ORIGINAL s as C7 <br />