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UNDERGROUWTANK PROGRAM OFFICIAL INSP�TION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME ' PHONETONNO, CA 5205. 46893423 COUNTY # q <br /> SITE NAME: © INSPECTION DATE: <br /> SITE ADDRESS: / J �� CITY/STATE/ZIP <br /> CEJ KJ ' <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK 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 /> 'A-ti O -�I 1'i:-J2. J / EXP.D EXP.DATE EXP.DATE_ EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MIhEOR <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 11 112 <br /> APPROVED MONITOR FREOUENCY 13 114 <br /> MONITORING RECORDS MAINTAINED 15 16 y <br /> ACCESS CASING SECURED 17 18 Y <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN [33 <br /> 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 28 <br /> SAMPLING 30 <br /> APPROVED TANK REPAIRS 32 <br /> UNAUTHORIZED RELEASES REPORTED 34SAFETY HAZARD 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 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 /> 59 <br /> MAJOR 57 MINOR a NO <br /> VIOL VIOL. VIOL LJ <br /> OFFICE: INSP: VJ RECEIVED BY: <br /> t <br /> TITLE: } PHONE: BECK: <br />