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UNDERGROUN`, OFFICIAL EON REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME t, / PHONEY NO. 4 CA 893423 5205 COUNTY # <br /> SITE NAME: &Z �S INSPECTION DATE: <br /> SITE ADDRESS:J3 3' 3 -7 r�n.R/L �/ CITY/STATE/ZIP Lp <br /> CHANGES SITE/l[OWNER/PERMIT? <br /> YES NO TANK / TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? coMPUTER COMPUTE COMPUTER COMPUTER <br /> NUMBER NUMBER �/�°� NUMBER NUMBER <br /> T`,((?E OF INSPECTION SITE COMPUTER# PER# PER# P'T PER # PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> I N <br /> OPERATIONAL TANK TANK co MOR <br /> MAJOR MNOR <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 1 TT_(/ <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 �... / <br /> INVENTORY RECONCILIATION 21 2 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29t37 <br /> APPROVED TANK REPAIRS 31 <br /> UNAUTHORIZED RELEASES REPORTED 33 <br /> SAFETY HAZARD 35 <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL I38 39 <br /> FLAMMABLE VAPORS REMOVED W43 <br /> ACCESS LOCATIONS SEALED 2POWER DISCONNECTED OWNER/OPERATOR MONITORING 5 <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 REPR�E3E TT VIOLMUST GOR CTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 58 59 <br /> MAJOR 57 MINOR NO <br /> VIOL. VIOL VIOL. <br /> OFFICE: INSPZj RECEIV BY: <br /> TITLE: PH E: RECK: <br /> HUT-3 ORIGINAL 5/W OM <br />