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UNDERGROLE''3I�r�A NK PROGRAM OFFICIAL INSP�C N REPORT I ?jp 3 <br /> ALN JOAQUIN HEALTH DISTRI14 <br /> 1641 E. HAZELTON AVE. <br /> COUNTY NAME PHONETONNO, CA 95205 <br /> . 468-3423 COUNTY # <br /> SITE NAME: INSPECTION DATE. p <br /> SITE ADDRESS: CITY/STATE/ZIP S�U( 7Ui✓� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPON NUMBER�p NUMBER NUMBER NUMBER <br /> EC ISITE COMPUTER# <br /> I Jj v <br /> PER#'T PER# PER# PER # <br /> EXP.DATE "! EXP.DATE EXP,DATE EXP.DATE <br /> TANK CONTENTS '' °a �," ds <br /> OPERATIONAL TANK x� NMI- -a <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 110 <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 22 <br /> TANK GAUGING 23 24 <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 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE `S <br /> r..e .�.-m,�z <br /> REMOVAL OF RESIDUAL 38 39 _ <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 _ <br /> POWER DISCONNECTED 43 _ <br /> OWNER/OPERATOR MONITORING 144 145 <br /> 770 <br /> PERMANENT TANK CLOSURE F kms ' <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 A� <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL ❑ VIOL. ❑ VIOL.K <br /> OFFICE: INS P:/t/ RECEIVED BY: <br /> TITLE: �1 f PHONE: BECK: <br /> siva O <br /> HUT-3 ORIGINAL ,:- <br />