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UNDERGROUN^ TANK PROGRAM OFFICIAL INSPEr-TION REPORT <br /> .;AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVECA 95205. <br /> BOUNTY NAME PHONETNO. 468 3423 COUNTY # <br /> �IorTE NAME: v' 1 / INSPECTION DATE: <br /> TE ADDRESS: 1 S3SS (/ rt CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> =PE OF INSPECTION IPE # / PER# 2— PER# PER# <br /> /^QliL /il.� EXP DATE r EXP.DATE EXP.DATE EXP DATE I <br /> )PERATIONAL TANK TANK CO <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 _ <br /> APPROVED CONSTRUCTION 5 6 — - <br /> ITTEN MONITORING PROCEDURES 7 8 .�. ----- ' <br /> APPROVED MONITORING SYSTEM 9 10 <br /> AONITORING SYSTEM 11 12 - <br /> P%PPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 — <br /> rNVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 - <br /> APPROVED RESPONSE PLAN 25 <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 <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 36 39 _.. _. .-_...__ _._....._._._ _-_..._..__ <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 ..___._.....-.. ......__. <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> T <br /> PERMANENT TANK CLOSURE i <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 -.. <br /> PIPING 46 49 <br /> FLAMMABLE VAPORS REMOVEDUNAUTHORIZED RELEASE 51 52 -._. -....__.___ . -_..._ . <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> i MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTE/DJ AS <br /> YSTEM STATUS(MUST MARK ONE) FoikCWS: d <br /> 4257 <br /> MAJOR 57 MINOR 58 NO 59Eg <br /> L <br /> VIOL ❑ VIOL ❑ VIOL - <br /> OFFICE: INSP: /I �� oz, RECEIVED BY: <br /> I TITLE: Ci�S PHONE: RECK: <br /> L - sr� e <br />