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.y UNDERGROU&TANK PROGRAM OFFICIAL INSP ION REPORT <br />AN JOAQUIN HEALTH DISTRIC <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: <br />INSPECTION DATE: --,-10 <br />SITE ADDRESS: 2.3 G/ S <br />5 � 1 <br />CITY/STATE/ZIP <br />V/, <br />CHANGES SITE /OWNER/ <br />YES <br />NO <br />TANK <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER %' <br />NUMBER / <br />_S— <br />COMPUTER <br />NUMBER /�� <br />6 <br />COMPUTER <br />NUMBER�oo <br />COMPUTER <br />NUMBER <br />TYPE OF IN PE TION <br />SITE COMPUTER # <br />PER V <br />PER # �o <br />PER # <br />PER # <br />'— <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERAT ONAL TANK <br />TANK CONnNI <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4- <br />APPROVED CONSTRUCTION <br />5 <br />_ <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />- <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20- <br />- - <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />_ <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />i <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />- -- <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />147 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />152 <br />SAMPLING <br />5354 <br />---_. <br />----_......._.. <br />--- -- _ <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />" <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 <br />59 <br />MAJMINOR No <br />OR ❑ ❑ <br />❑ <br />VIOL VIOL VOL. <br />OFFICE:INSP: <br />7/ <br />, / _RECEIVED <br />�/ �f�--�. <br />TITLFl <br />O �iid� <br />PHONE: <br />R <br />sir. <br />HUT -3 ORIGINAL 5/88 ©M <br />