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UNDERGROUN' TANK PROGRAM OFFICIAL INSPF^TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> �' 1601 E. HAZELTON AVE. <br /> COUNTY NAMEN STOCKTON, CA 95205 COUNTY # 7 <br /> PHONE NO. 468-3423 ✓ <br /> SITE NAME: n INSPECTION DATE: w <br /> SITE ADDRESS: fro E CITY/STATE/ZIP <br /> CHANGES SITE/OWN R/PERMIT? Y SNO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? N0 COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> NP 1,23 EXP.DATE EXP.DATE EXP DATE EXP DATE <br /> OPERATIONAL TANK TANK CONTEN S <br /> MAJOW 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 2 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 W4445 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE .. <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(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 j <br /> MINOR 58 NO 59 <br /> VIOL VIOL ❑ VIOL❑ <br /> OFFICE: INSP�: � � ZE <br /> IV D BY: <br /> TITLE: R6 : RECK: <br /> NUT-3 ORIGINAL ae O, <br />