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UNDERGROI TANK PROGRAM OFFICIAL INS TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICTum- <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95245 COUNTY # <br /> COUNTY NAME PHONE NO. 468-3423 <br /> SITE NAME. INSPECTION DATE: <br /> SITE ADDRESS: 7 CITY/STATE/ZIP <br /> TANK TANK <br /> CHANGES SITE YES NO TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPEC710N SITE COMPUTER# PER# PER# PER# PER# <br /> CS�!� - "� EXP.DATE' _ EXP.DATE _ EXP.DATE _ EXP.DATE _ - <br /> OPERATIONAL TANK TANK R MI NSS <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 t/ <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 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING E37 <br /> APPROVED TANK REPAIRS <br /> UNAUTHORIZED RELEASES REPORTED <br /> SAFETY HAZARD <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED m 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE i <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 - <br /> FLAMMABLE VAPORS REMOVED 50 <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(tAUST MARK ONE) FOLL WS:��.r, <br /> 58 59 <br /> MAJOR 57 MINOR NO <br /> VIOL VIOL. ❑ VIOL❑ <br /> OFFICE: INS P _ RECEIVED BY: <br /> TIT PHONE: RECK: <br /> 5188 <br />