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UNDERGROU" TANK PROGRAM OFFICIAL INSF -'TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICIo" <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME P ONETNO. 468-342ON, CA 3 COUNTY # <br /> 3 <br /> SITE NAME: <br /> / INSPECTION DATE: <br /> SITE ADDRESS: f� �. C` GLt CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES TAN 01 TANK v�v TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER 10Y 7-0/ NUMBER IvY7-0 NUMBER NUMBER <br /> PER# PER# PER # PER# <br /> T�"/� rernovu I Uy� EXP.DATE' EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> _h VU�lo <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 - C_/1�f -•`--`--�- - --- --- - - <br /> ` / <br /> APPROVED CONSTRUCTION 5 6 /epS <br /> WRITTEN MONITORING PROCEDURES 7 g <br /> APPROVED MONITORING SYSTEM g 10 ----~ - --- --- --- <br /> MONITORING SYSTEM11 12 <br /> _.-... _.. <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 ____. <br /> PIPING 19 <br /> _._......_.._._._._.._----___._. ._.---__.____._._. <br /> 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 <br /> 37 71 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> OWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> -....__. <br /> (PING .". ._.. <br /> 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: <br /> _TSljl,��fJ�yl!_zsO/ a} .h"ES�._��Or �- <br /> 58 JS CJICI��i <_O�--J�Q��'cf-_-GY f_SC1177 �� _r111/ ll <br /> MAJOR El MINOR NO <br /> VIOL. 59 <br /> VIOL. VIOL_ <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: l,68 _ 3 y�� Rr_cK: <br /> HUT-3 ORIGINAL T_ ,,ay FSM <br />