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UNDERGROU TANK PROGRAM OFFICIAL INSP TION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> PHHONEONE NNOO. 4 4668-3423 <br /> COUNTY NAME &9,n&9,nl,C- S , 95205 COUNTY #3 9 <br /> SITE NAME: f (�Y� INSPECTION DATE: <br /> SITE ADDRESS:6156,6 -/I!l„YL 0 'LsA •CITY/STATE/ZIP G6 ?5a <br /> CHANGES SITE/OWNER/PERMIT? YES l NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECT <br /> ION SITE COMPUTER# PER# PER# PER# - PER# <br /> r {juE f e- Q 5 g EXP.DATE' EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL. TANK TANK CONTENTS J� <br /> MAJOR I 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 9 110 - <br /> MONITORING <br /> 0 ,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 'T <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 26 <br /> SAMPLING 29 130 <br /> APPROVED TANK REPAIRS 31 132 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 136 <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 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: aa qj2, <br /> MAJOR 57 MINOR 58 59 <br /> NO <br /> VIOL ❑ VIOL ❑ VIOL.❑ <br /> OFFICE: (NSP: - IC�i7'v <br /> TITLE: S . PHONE! _S f RECK: <br /> HUT-3 ORIGINAL 5/88 & <br />