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UNDERGROLINF�-ANK PROGRAM OFFICIAL INS c''-tON REPORT <br /> { AN JOAQUIN HEALTH f <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME P ONETONNO, CA 5205 <br /> . 6853423 COUNTY # <br /> INSPECTION DATE: <br /> SITE NAME: 19 p'- "9 %D a/ -S <br /> SITE ADDRESS: a g f/ �`l n CITY/STATE/ZIP SL/�-140 <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 /> TYPE OF INSPECTION SITE COMPUTER# PER# /5;7o2 Q PER PER# PER # <br /> ���o✓� �5 ? �- <br /> EXP.DATE EXP DATE EXP DATE i EXP DATE <br /> TANK CONTENTS t'``s ' u', f' z �Cg ,< ,. e•.,*�'v-;a s„"i, c,; x L�}g� ^Y. ° x.s �w <br /> OPERATIONAL TANK <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 - -- <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 � � } <br /> APPROVED CONSTRUCTION 5 6plj_ _ _,}_ _ <br /> WRITTEN MONITORING PROCEDURES 7 8 v <br /> APPROVED MONITORING SYSTEM 9 10 _ <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 � <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 122 <br /> TANK GAUGING 23 24 W — <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 13.4 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 y <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 ! <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: s G u 7`Tt,l.. <br /> MA 30R 57 MINOR 58 NO X59 to <br /> VIOL ❑ VIOL. Li <br /> L�J <br /> OFFICE: INSP: d. G Z RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> r <br /> HUT–l" CRIGINAL =rsa Of <br />