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UNDERGROU*TANK PROGRAM OFFICIAL INSPOTION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT , ' <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME NO. 46 STOCKTCA 95 95205 COUNTY # 3 <br /> 6CL PHONE NO. 23 <br /> SITE NAME: INSPECTION DATE: d_a (o'p <br /> SITE ADDRESS: 7 �1 ��- CITY/STATE/ZIP C19 1?5cZ <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK Q / TANK O vL TANK Q 3 TANK O <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> r o(A. YAR. 100-7 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS { <br /> MAJO MINOR <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 �Q <br /> APPROVED MONITORING SYSTEM 9 10 li <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 _ <br /> MONITORING RECORDS MAINTAINED 15 116 <br /> ACCESS CASING SECURED 17 118 <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 40 <br /> ACCESS LOCATIONS SEALED 41 42 _ <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPUNG 53 54 <br /> IMPROPER ABANDONMENT 55 56 Iz <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOLp�r VIOL ❑ VIOL❑ <br /> e <br /> OFFICE: <br /> ToT s ado <br /> TITLE: 1 ZS PHONE: RECK: <br /> HUT-3 ORIGINAL seas (D' <br />