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UNDERGROU TANK PROGRAM OFFICIAL INSP TION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> �1 1601 E. HAZELTON AVE. <br /> COUNTY NAME Sai4 J06-4 SHONE NO.ON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: c ' l 44 () 7(' INSPECTION DATE: <br /> SITE ADDRESS: f G( � CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK 1 TANK .2_ TANK 3 TANK 271- <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> PER # PER# PER # PER # <br /> l� EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <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 Y'e ,(`-y-CC� <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 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 31 132 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 136 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40mz <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED m 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 147 <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) FO4LOWS: <br /> L <br /> 58 59 <br /> MAJORMINOR NO <br /> V <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: P E S PHONE: BECK: <br /> HUT-3 ORIGINAL 5/88 �" <br />