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j UNDERGROL# TANK PROGRAM OFFICIAL INS#TION REPORT T <br /> � jSAN JOAQUIN HEALTH DISTRICI,,� <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME SQA 1 J 6Cl STOCKTON, CA u1 N PHONE NO. 468 3423 COUNTY # -3cq <br /> SITE NAME: o' n n_t-j N INSPECTION DATE: <br /> SITE ADDRESS:�2O S CITY/STATE/ZIPS1�C tJ CA <br /> CHANGES SITE/OWNER/PERMIT? NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? s COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> U� O PER# PER # PER# PER# <br /> EXP DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR 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 '— --- <br /> APPROVED MONITORING SYSTEM 9 10 --- - --------- <br /> MONITORING SYSTEM 11 12 ---... <br /> APPROVED MONITOR FREQUENCY 13 14 -------- <br /> MONITORING RECORDS MAINTAINED 15 16 ---- <br /> ACCESS CASING SECURED 17 18 - <br /> PIPING 19 20 ---- <br /> INVENTORY RECONCILIATION 27 22 — -- <br /> TANK GAUGING 23 24 <br /> APPROVEDRESPONSE PLAN 25 26 -------- <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 ---- <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRSr 31 32 """----'-- <br /> i <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 /> i <br /> PERMANENT TANK CLOSURE `' <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 1 <br /> UNAUTHORIZED RELEASE 51 52 { ------ - <br /> SAMPLING 53 54 --._.... <br /> IMPROPER ABANDONMENT 55 56 '-- <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) Na V,o la}m✓S • : c ec 2 ' . �� fiej es•/p• ;/Z <br /> :12S-1,6(� <br /> OCA W-�cd dun ryw' I FOLLOWS <br /> e d^ otu ia' <br /> MAJORn (crc <br /> 57 MINOR 58 NO 59 N�7' > e ✓a _ Z v P.., <br /> V <br /> VIOL. El VIOL. ❑ IOL❑ jy1 fa P 4 <br /> I r/cKSssrJ idQ 23s-/ /(Aa...;�'rrf' cr ✓nNs�r<r 4�_ <br /> u e t � ND w i <br /> OFFICE: INSP:C��eS NwNt RECEIVED B <br /> TITLE: E , N 1 PHONE: RECK: <br />—N[IT—R 0RIG,INAI. . <br /> s/ee CSM <br />