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UNDERGROUN^ TANK PROGRAM OFFICIAL INSPF"TION REPORT <br /> IAN JOAQUIN HEAaLITH DISTRICT1601 E. HAZELTAVE. <br /> COUNTY NAME STOCKPHONE TNO. 468-342ON, CA 3 COUNTY # 3 y <br /> SITE NAME: <br /> G� 6 O L I« INSPECTION DATE: 6_ kl'—1?3 <br /> SITE ADDRESS: //_o 0 F /� CITY/STATE/ZIP (P6 ?s � 76 <br /> CHANGES SITE/OWNER/PERMITT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTE a COMPUTER COMPUTER COMPUTER <br /> TYPE Q�WSP CTION SITE COMPUTER NUMBERr G�Gyf'f, NUMBER NUMBER NUMBER <br /> I% �// PER# (_1 71 _t PER# PER# PER# <br /> VI, 0 1 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANKcoNreNls wr <br /> MAJOR FmINOR <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 HAZARD35 36 - -_. _..... _._... <br /> CONDITIONS ABATED 37 -_._ _...._. .. .... _. <br /> TEMPORARY TANK CLOSURE <br /> f' T}'il <br /> ld' .?�\. <br /> REMOVAL OF RESIDUAL W43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE } zgmmfm ' <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 LL <br /> THE MARKED ITEM REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOL OWS: E k !?-t/ Z'L°G!5/ 0-7, <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP: f - RECEIVED BY: <br /> TITLE' '7 HONE: BECK: <br />—�iUT-3 ORIGINAL siea O� <br />