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UNDERGROU' TANK PROGRAM OFFICIAL INSTION REPORT <br />SAN JOAQUIN HEALTH DISTRICW <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCK ON, CA 95205 <br />PHONE NO. 468-3423 COUNTY # <br />SITE NAME: _ <br />�a�%Sp� s Surir�s� /)Qin y INSPECTION DATE: <br />SITE ADDRESS. <br />a3 9 s, CITY/STATE/ZIP n <br />s� - <br />CHANGES SITE/OWNER/PERMIT <br />FORM A AND/OR B SUBMITTED? <br />TYPE OF INSPECTION ciTc ,nr <br />,KouI /y <br />OPERATIONAL TANK <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS. REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />SYSTEM STATUS (MUST MARK ONE) <br />NO TANK <br />TANK <br />TANK <br />2 <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />JTA <br />COMPUTER <br />PER # / <br />8 <br />NUMBER <br />NUMBER <br />TANK CONTENTS <br />MAJOR MINOR <br />1 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />8 <br />9 <br />10 <br />11 <br />12 <br />13 <br />14 <br />15 <br />16 <br />17 <br />18 <br />19 <br />20 <br />21 <br />22 <br />23 <br />24 <br />25 <br />26 <br />27 <br />28 <br />29 <br />30 <br />31 <br />32 <br />33 <br />34 <br />35 <br />36 <br />�® <br />�a <br />MCC <br />mrall <br />®ism <br />NIIIIIIIII[m <br />MAJOR 57 <br />MINOR 58 Np 59 <br />VIOL. ❑ VIOL. ❑- VIOL. <br />PER# jY(�?-OD- PER#/L/k3'V� PER# <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED CTED AS <br />RECEIVED BY����� <br />TITLE:I <br />/,c!!/moi Girr.PiS�" PH]NE: RE <br />-3 y(o� <br />HUT -3 ORIGINAL <br />5/88 O, <br />