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UNDERGROUNTANK PROGRAM OFFICIAL INSPv7"TION REPORT <br /> I .,oAN JOAQUIN HEALTH DISTRIZFi � <br /> 1601 E. HAZELTON AVE. <br /> 205 <br /> COUNTY NAME O� PHONETONNO. 468-3423 COUNTY # <br /> SITE NAME: �� Y1 :!5CAv�encjOrs INSPECTION DATE: <br /> SITE ADDRESS: L� O AhvLi �&lvc) <br /> CITY/STATE/ZIP g � <br /> CHANGES SITE/ YE NO TANK p TANK �Z TANK b3 TANK <br /> FORM A AND/ B Su MITT n COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TY E OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> U U / / ! 5— EXP.DATE' EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANKTA <br /> .c coNTENTs <br /> MAJOR I MINOR w:' ,- ' W> <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 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 114 <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 <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 4a m <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <� <br /> ..«. <br /> i4 S <br /> RE ESIDU 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 155 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST 13E CORRE ED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: d022�A' 0&1117 <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL. ❑ VIOL. LJVIOL <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> HUT-3 CRiC3VAL 5/88 ©N <br />