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UNDERGROI""O TANK PROGRAM OFFICIAL INSr' CTION REPORT <br /> �.. SAN JOAOUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> 205 <br /> COUNTY NAME PHONETNO. 468-3 423 COUNTY # <br /> SITE NAME: 5, roc _ INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP ✓�4a�ec� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER �(.�b-p/ NUMBER NUMBER NUMBER <br /> FCHANGE <br /> ECTION SITE COMPUTER# �6 <br /> PER# PER# PER# PER a <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> NAL TANK <br /> nTANKMI NORMINORPERATE 2ONDITIONS TO OPERATE 4ONSTRUCTION 6 <br /> WRITTEN MONITORING PROCEDURES 8APPROVED MONITORING SYSTEM 10MONITORING SYSTEM 12 1 o'U u o S0 D fsE'f? <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 HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 r43 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING 44 <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: /ia h c ro C S S¢i <br /> 57 58 <br /> NIAJOR MINOR NO 69 t.S.t <br /> VIOL. ❑ VIOL. ❑ VIOL. I. ' <br /> OFFICE: INSP: l Z RECEIVED BY: <br /> �� �2ocv2ee� A /YLe /7Zc Q � <br /> TITLE: R, E 'q, S PHONE: BECK: <br /> HUT-3 ORIGINAL siea 0' <br /> _I <br />