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UNDERGROUP," TANK PROGRAM OFFICIAL INSPE^TION REPORT f SAN JOAQUIN HEALTH DIST COUNTY NAME • 1601 E.STOCKTOAN, CAO N AVE. 5205 PHONE NO. 468-3423 COUNTY # FFORM E: INSPECTION DATE: �/sl5j RESS: lO�yp £` o c CITY/STATE/ZIP S/v� � SITE/OWNER/PERMIT? YES NO TA TANK TANK ND/OR B SUBMITTED? COMPUTER TANK COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER PER# 't�-Sa-�� PER# R# PER# EXP..D EXP.DATE EXP.DATE EXP.DATE OPERATIONAL TANK TANK coNTeN.s / MAJOR MINOR LSM PERMIT T OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 --- WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 10 MONITORING SYSTEM 11 12 APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 PIPING 19 20 INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 —, APPROVED RESPONSE PLAN 25 26 — UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 �....—._- UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 - CONDITIONS ABATED 37 '--'----- TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED 40 `----`"---"--"`"-`"- --------- ACCESS LOCATIONS SEALED 41 42 --- _ POWER DISCONNECTED 43 --- OWNER/OPERATOR MONITORING 44 45 - MANENT TANK CLOSURE REM OV S 46 47 PIPING 48 49 FLAMMABLE VAPORS REMOVED 50 ---------.-. UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOW§ dl MAJOR 57 MINOR 58 NO 59 VIOL. ❑ VIOL. ❑ VIOL OFFICE: INSP: p. RECEIVED BY: TITLE: PHONE: I RECK: HUT-3 ORIGINAL 5 98