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UNDERGROU ir TANK PROGRAM OFFICIAL INSPF ON REPORT � 4N JOAQUIN HEALTH DIST ;T I - 1601 E. HAZELTON AVE. COUNTY NAME OE NO. 46 8-3423 95205 PHONNE NO. 46COUNTY # P SITE NAME: --7 INSPECTION DATES SITE ADDRESS: I /�-rF / _ CITY/STATE/ZIP ys-� CHANGES SITE/OWNER/PERMIT? YES NO VTANK TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTERNUMBER / NUMBER NUMBER NUMBER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# PER # PER # PER# PER # EXP.DATE EXP.DATE EXP.DATE- EXP.DATE OPERATIONAL TANK TANK CONTENTS MAJOR MINOR a , PERMIT TO OPERATE 1 2 CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 Q� WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 10 i MONITORING SYSTEM 11 12 —� APPROVED MONITOR FREQUENCY 13 14 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 18 PIPING 19 20 1 INVENTORY RECONCILIATION 21 22 ---�--- TANK GAUGING 23 24 —_ APPROVED RESPONSE PLAN 25 26 UNAUTHORIZED RELEASE OCCURRENCE 27 28 _ SAMPLING 29 130 APPROVED TANK REPAIRS 31 132 UNAUTHORIZED RELEASES REPORTED 33 34 SAFETY HAZARD 35 36 _ ----_-- v--- - - '-- CONDITIONS ABATED VZZ, 37 TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED 40 ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED M 43 OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE REMOVAL OF RESIDUAL MATERIALS 46 47 _ PIPING 48 49 _ FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 SAMPLING 53 54 IMPROPER ABANDONMENT 155 156 _ THE MARKED ITEMS REPRESENT VIOLATIONS/AND MUST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: l O 58 MAJOR 57 MINOR NO 9 VIOL. ❑ VIOL. ❑ VIOL OFFICE: INSP: RECEIVED BY: TITLE. PHONE: RECK: HUT-3 / ORIGINAL 5/88 0