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UNDERGROUKD TANK PROGRAM OFFICIAL INSPECTION REPORT <br /> COUNTY NAME � <br /> SITE NAME INSP DATE: <br /> I SITE ADDRESS f �G < C/5/Z <br /> CHANGES SITE/OWNER/OPER 7 TANK TANK TANK TANK <br /> YES NO M.F.R. SUBMIT. IDM ID M ID N ID 0 <br /> SITE COMP. # TPE OF INSP PER I PER N PER T PER I <br /> EXP DATE EXP DATE F" DATE EXP DATE <br /> OPERATIONAL VIOLATIONS <br /> 1. Permit to Operate <br /> 2. Change In Cond. to Operate <br /> 3. Approved Construction <br /> 4. Written Monitoring Procedures — <br /> 5. Approved Monitoring System <br /> 6. Monitoring System Operational t� �. - : <br /> 7. Approved Monitoring Frequency ( ic_ _, r �� <br /> 8. Monitoring Records Maintained <br /> 9. Access Casing Secured <br /> 10. Piping - <br /> 11. Inventory Reconciliation <br /> 12. Tank Guaging <br /> 13. Approved Response Plan <br /> 14. Unauthorized Release Occurrence Ai <br /> 15. Sampling <br /> t16. Approved Tank Repairs <br /> 17. Unauthorized Releases Reported a <br /> 18 Safety Hazard ✓..' - - <br /> 19. Conditions Abated <br /> TOO40RARY CLOSURE <br /> 20. Removal of Residual Materials <br /> 21. Flammable Vapors Removed <br /> 22. Access Locations Sealed <br /> 23. Power Disconnected <br /> 24. Owner/Operator Monitoring <br /> PE1ftVQ21T CLOSURE <br /> 2S. Removal of Residual Materials <br /> 26. Piping <br /> 27. Flammable Vapors Removed <br /> 28. Unauthorized Release <br /> 29 Sampling <br /> 30. Improper Abandonment <br /> The marked !twos represent violations and mint be corrected as follows: <br /> l INSP: <br /> Ay`i`�A'��fN LOCAL. ��EALTH DfSTRiC <br /> _—t T]OX 2009 <br /> 5T `7 CALIF. 95201 �� <br /> PHONE <br /> ATTN ENWiRON, HEALTH T RECHECK <br />