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UNDERGRO TANK PROGRAM OFFICIAL INS ION REPORT MWAN JOAQUIN HEALTH DISTRIC 1601 E. HAZELTON AVE. COUNTY NAME PHONETNO. 4 CA 8934203 COUNTY # 3q SITE NAME: Cq / _ M./ U / 5a�0 287—Uy17 EC ON DATE: -31 SITE ADDRESS: �7 h L ) /�/ hKi%� T�h CITY/STATE/ZIP CHANGES SITE YES NO TANK TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER12 r7q COMPUTER COMPUTER COMPUTER NUMBER 7 NUMBER NUMBER NUMBER TYPE OF INSPECTION SITE COMPUTER# PER # PER# PER# PER# EXP.DATE- EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK R eNis MAJOR PERMIT TO OPERATE 1 2 __. _. .. _.. CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 10 _.. MONITORING SYSTEM 11 12 _ APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 PIPING 19 -90 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 _ APPROVED TANK REPAIRS 31 32 _ UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 CONDITIONS ABATED 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 _ FLAMMABLE VAPORS REMOVED 40 _ ACCESS LOCATIONS SEALED 41 42 _ POWER DISCONNECTED 43 OWNER/OPERATOR MONITORING 44 45 77 - 7 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 _ PIPING 48 49 _ FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 ...:...._ _ -- SAMPLING 53 5477 _ IMPROPER ABANDONMENT 55 S6 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: MAJOR 57 MINOR 58 NO 59 VIOL. VIOL. ❑ VIOL.❑ OFFICE: INSP:Ij� �, RECEIVED BY: TITLE:�✓ PHONE: BECK: siea OM HUT-3 ORIGINAL