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UNDERGROUP TANK PROGRAM OFFICIAL INSP` -TION REPORT <br /> ,SAN JOAQUIN HEALTH DISTRICT4 <br /> �- 1601 E. HAZELTON AVE. <br /> COUNTY NAME, )4v PHONETNO. 468-CA 3423 <br /> COUNTY # �' l <br /> SITE NAME: g &T `- nL p� a INSPECTION DATE: (� <br /> SITE ADDRESS: /p2€, w�-'-, CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? dS LNQ TANK TANK 6 ?/ TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TOFOF I�N SITECOMPUTER# PER# PER# PER# PER# <br /> 3 k <br /> V EXP DATE EXP DATE EXP DATE EXP.DATE <br /> OPERATIONAL TANK <br /> TMK coN MINOR <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 /4 <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 W43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <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 Z4i ...�.._..� <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOW <br /> MAJOR 57 MINOR ❑58 NO ❑9 9.� <br /> VIOL. VIOL. VIOL <br /> OFFICE: INSP: `_I / 0 0 RECEIVED BY: <br /> TITLE:9-64f-� PHONE: PECK: <br /> HUT-3 ORIGINAL sisa OM <br />