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UNDERGROUP` TANK PROGRAM OFFICIAL INSPr BION REPORT <br />SAN JOAQUIN HEALTH DISTRICT <br />163-' ESI ^"-:-AVE. '-/`FS p/. <br />COUNTY NAME tC� L l� sro s�r.cK� , aszoz COUNTY # <br />(, {�(�'j� PHONE NO.468-3423 KZ0414",:�_3qzo <br />SITE NAME: <br />env ro n <br />INSPECTION DATE: <br />SITE ADDRESS: Z �A I jbd CCA, � CDS CITY/STATE/ZIP <br />r �� <br />CHANGES SITE/OWNER/PERMIT? YESO <br />TANK TANK tom; <br />TANK 0 <br />TANK 0/71 - <br />FORM A AND/OR B SUBMITTED? QLD <br />COMPUTER COMPUTER <br />COMPUTER <br />COMPUTE <br />NUMBER NUMBER <br />PER # PER # <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />TYPOF INSPECTION <br />6u <br />SITE COMPUT R # <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />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 <br />�- <br />MONITORING SYSTEM 11 12 <br />APPROVED MONITOR FREQUENCY 1314 <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 />_ <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 />I <br />ACCESS LOCATIONS SEALED 41 42 <br />POWER DISCONNECTED 43 <br />{ <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 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS: <br />57 58 59 <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL. VIOL. VIOL. <br />OFFICE: <br />INSP: <br />;/A <br />RECEI B <br />TITLE: &W5 <br />PHO : <br />RECK: <br />HUT -3 ORIGINAL 5/88 01 <br />