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UNDERGROIp TANK PROGRAM OFFICIAL INSTION REPORT <br />SAN JOAQUIN HEALTH DISTRIC <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 <br />oul, ll ., COIUITV d6 <br />`HUT -3 ORIGINAL 5/M am <br />V'J4LJ <br />vv�, • <br />SITE NAME: - <br />INSPECTION <br />DATE: <br />141411 <br />SITE ADDRESS: 3�0 SGk <br />CITY/STATE/ZIP <br />- <br />�7 <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK <br />TANK <br />0� <br />TA K <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />TANK <br />COMPUTER COMPUTER <br />TYPE OF INSPECTION SITE COMPUTER # <br />NUMBER /orf / - p / <br />NUMBER <br />NUMBER NUMBER <br />PER # <br />PER # <br />PER # PER # <br />b <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />- <br />--"-"- ----�"-- - <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />0---- <br />-- <br />WRITTEN MONITORING PROCEDURES <br />7 <br />-- <br />APPROVED MONITORING SYSTEM <br />9 <br />- <br />MONITORING SYSTEM <br />11 <br />- --- <br />APPROVED MONITOR FREQUENCY <br />13 <br />4 <br />- - <br />MONITORINGRECORDSMAINTAINED <br />15 <br />16 <br />-- ----- - <br />ACCESS CASING SECURED <br />77 <br />18 <br />-- - - <br />PIPING <br />19 <br />20 <br />" <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />-- <br />SAMPLING <br />APPROVED TANK REPAIRS <br />31 <br />32- <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />"- -- <br />SAFETY HAZARD <br />35 <br />36 <br />----- <br />CONDITIONS ABATED"' <br />-- <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />y: <br />----" <br />-- ----- ------------- <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />--�—� <br />-" <br />POWER DISCONNECTED <br />43 <br />- - <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />--- <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />--- <br />PIPING <br />48 <br />49 <br />- <br />- <br />FLAMMABLE VAPORS REMOVED <br />50----"-�—"- <br />UNAUTHORIZED RELEASE <br />51 <br />52----'�" <br />SAMPLING <br />53 <br />54_... <br />__,,.�.._�_.._...._"... <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS <br />AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />I . -� <br />N.0 <vn ! <br />^ ; 5 <br />MAJOR 57 MINOR NO <br />VIOL ❑ <br />59 <br />❑ <br />IY—A;6 <br />' s <br />VIOL. VIOL <br />OFFICE: <br />INSP: <br />� <br />RECEIVED BY: <br />/;,Li�- <br />TITLE: �G�s <br />PHONE: <br />RECK: <br />`HUT -3 ORIGINAL 5/M am <br />