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UNDERGROU�TANK PROGRAM OFFICIAL INSPRNTION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME PHONEY NO. 468-3423 205 32 <br /> COUNTY # <br /> SITE NAME: 1A A & _ Q -siSPE TI N ATE: <br /> le <br /> SITE ADDRESS: J o G Y/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO ANK , TANK NK TANK <br /> FORM A AND/OR B SUBMITTED? COMPO'S�EE� OM R f COMPUTE COMPUTER <br /> NUMBEFI/(/ UMBER�.L NUMBFL�.J NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# 6'V O 71 PER#Qg o Q PER �0 L) PER # <br /> EXP-DATE +-Y EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK co <br /> MAUlm—OR <br /> MINOR <br /> PERMIT TO OPERATE 1 2 -.- - - --- <br /> CHANGE IN CONDITIONS TO OPERATE 3 4APPROVEDCONSTRUCTION5 6 -,- <br /> WRITTEN MONITORING PROCEDURES 7 8 _. ------------ <br /> APPROVED <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 2 <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 39 <br /> FLAMMABLE VAPORS REMOVED 40 __.___._....______. <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 ... <br /> OWNER/OPERATOR MONITORING 44 45 <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 y' <br /> THE MARI/�JQJITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS , Lib <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS` R <br /> �d <br /> MAJOR 57 MINOR 58 NO 59A4 0 Y TDtQ-ot AJ c- <br /> VIOL. VIOL. ❑ VIOL.❑ O w w b <br /> LL sL/ G1'1N' .s <br /> OFFICE: INS RECEIVED BY: <br /> Z CJ <br /> TITLE: PHONE- RECK: <br /> - � <br /> si8a ©m <br /> HUT-3 ORIGINAL <br />