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UNDERGROUN- TANK PROGRAM OFFICIAL INSPF4`TION REPORT <br /> USAN JOAQUIN HEALITH DISTRICT1601 E. HAZELAVE. S <br /> COUNTY NAME STOCKTON, CA 95205 COUNTI # 3 <br /> A) PHONE NO. 468-3423 <br /> SITE NAME: tb Oa+e INSPECTION DATE: t7 <br /> 11A <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> LLPER# /000V PER# /V 0o0j PER# PER# <br /> 0 UT7 N e. S EXP.DATE drp+X EXP.DATE�Ur L.• 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 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 1 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 29 30 - <br /> APPROVED TANK REPAIRS 31 132 <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD 35 136 <br /> CONDITIONS ABATED M 37 VA <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 q52 <br /> PIPING 48 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 SAMPLING 53 IMPROPER ABANDONMENT 55 <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 /> VIOL. VIOL ❑ VIOL❑ <br /> OFFICE: INSP: nkiGrY s 44u- RECEIVED <br /> TITLE: )ZV+S PW <br /> BECK: <br /> NUT-3 ORIGINAL 5/m ©m <br />