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UNDERGROU' TANK PROGRAM OFFICIAL INSP' TION REPORT <br /> -SAN JOAQUIN HEALTH DISTRICT <br /> l G 1601 E. HAZELTON STOCKTON, CA 5205 <br /> COUNTY NAME � C.(/n-/'. PHONE NO. 468-3423 COUNTY # <br /> J <br /> SITE NAME: -j S ti INSPECTION DATE: <br /> SITE ADDRESS: IN W, M tE <br /> CITY/STATE/ZIP g5 %CHANGES SITE/OWNER/PERMIT? YES TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? UTER COMPUTER COMPUTER COMPUTER <br /> ER NUMBER NUMBER NUMBER <br /> TYPE F INSPECTION SITE COMPUTER# PER# PER# PERDATE- EXP.DATE EXP_ E E .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 13 114 <br /> MONITORING RECORDS MAINTAINED [25126 <br /> 16 _ <br /> ACCESS CASING SECURED 18 <br /> PIPING 20 _ <br /> INVENTORY RECONCILIATION 22 _ <br /> TANK GAUGING 24 <br /> APPROVED RESPONSE PLAN UNAUTHORIZED RELEASE OCCURRENCE 28 SAMPLING 30 <br /> APPROVED TANK REPAIRS 32 <br /> UNAUTHORIZED RELEASES REPORTED 34SAFETY HAZARD 36 <br /> CONDITIONS ABATED 7 <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 T NK CLOSURE <br /> R LS 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: jaa Z <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. ❑ VIOL. LIVIOL. <br /> OFFICE: INSP:tam RECEIVED BY: <br /> TITLE: 5 gPHONE: BECK: <br /> HUT-3 !J� `��ORIGINAL 51ea O <br />