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UNDERGROUf&TANK PROGRAM OFFICIAL INSP TION REPORT <br /> USAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZEL-TON AVE. <br /> COUNTY NAME � J { STOCKTNO. 46 95205 COUNTY #_q <br /> OlN 22 IXI� �,,T7' PHONE NO. 468-3423 <br /> SITE NAME:. & r INSPECTION DATE: <br /> SITE ADDRESS: l mo f E I'1 W aO CITY/STATE/ZIP mop _oc' C� <br /> CHANGE IT OWNER/PERMIT? ClfV NO TANK vI TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? ves COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # II PER # PER # PER# <br /> g!serv'r 4sq'm EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TAN 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 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 _ <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <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/OPERATOR MONITORING 144 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 - �V <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS [MUST MARK ONE) FOLLOWS: b m-e� .2- f [ irrP .)d <br /> s ce"n ys <br /> x r~ c ^,��r C "' 2' <br /> MAJOR 57 MINOR 58 NO 59 b� S�uFO exz,vo, 6vcx3 !c'14 'Ilec <br /> VIOL. ❑ VIOL. ❑ VIOL. 4h p�/ 11-1114411-1 �!/ a <br /> $!V C�tJ VN Q dt7�'A) 0_7 6- -- <br /> OFFICE: INSO: RECEIVED BY: <br /> TITLE: {�� PHONE: RECK: <br /> HUT-3 ORIGINAL 5/88 <br />