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U*QROUND TANK OFFICIAL INSPECTION RIORT <br /> SAN JOAQUIN PUBLIC HEALTH BINVICIG <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 449 N:@on Joagulm atf@@t <br /> Mallino Addmw ff box 3®®COUNTY NAME outom,CA 06201-0308 COUNTY # <br /> SITE NAME! L N1 INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/HERMIT? YES NO TANK TANK 'TANK TANK <br /> FORM A AND/OR B SUBMIT-TED?- COMPUTER t OMPUTER �COMPUTE M COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER/40611 UMBE &6-0 NUMBER NUMBER <br /> PER# 604 PER# TC� PER# PER# <br /> E EXP:DATE X ATE P. <br /> TANK CONTENTS sm gg 4, <br /> 6ERAflONAL TANK <br /> NUMN MINI- Midi <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE a 4 <br /> APPROVED CONSTRUCTION <br /> WRITTEN MONITORING PROCEDURES 7 is <br /> APPROVED MONITORING SYSTEM 9 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 16 le <br /> ACCESS CASING SECURED 17 la <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 26 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 20 <br /> SAMPLING 29 w <br /> APPROVED TANK REPAIRS 31 OR <br /> UNAUTHORIZED RELEASES REPORTED 3M334 <br /> SAFETY HAZARD 36 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> its= <br /> REMOVAL OF RESIDUAL 30 39 <br /> FLAMMABLE VAPOR@ REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED = 43 <br /> OWNER/OPERATOR MONITORING 44 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 49 49 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 61 69 <br /> SAMPLING 93 54 <br /> IMPROPER ABANDONMENT 6§ §6 <br /> THE MARKED ITEMS REPHEENT VIOLATIONS AND MUST BE 0 RNPCzfffD AS <br /> -ol � --1 - - <br /> SYSTEM STATUS(MU§T MARK ONE) <br /> MAJOR <br /> FOLLOW@:- <br /> 0 <br /> 97 MINOR §9 No §9 <br /> VIOL: VIOL: VIOL:j& <br /> OFFICE: INSP! RECEIVED BY:: <br /> �vj <br /> 111 TITLE: PHONE:: HECK'6159v��5 1 <br /> HUT=3 Whig-Ofioinal Y@11@w z C)wn@fl§0@ov Pink-Fil@ Cow <br />