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UNDERGROUNn TANK PROGRAM OFFICIAL INSPFrTION REPORT <br />SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. ter' <br />COUNTY NAME srocKroN, CA 95205 COUNTY # <br />a PHONE NO. 468-3423 .i <br />HUT -3 ORIGINAL 5/88 OM <br />SITE NAME: <br />�ni 1N <br />INSPECTION DATE: <br />IS <br />SITE ADDRESS:p0 C�,cr�f1 <br />CITY/STATE/ZIP <br />S{trklol <br />G1} <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />TANK <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />!Jo <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />INSPECTIO=N <br />TYPE OF INSPECTION SITE COMPUTER # <br />NUMBER <br />NUMBER <br />NUMBER <br />NUMBER <br />o I Swn �1 b 9 G <br />PER # <br />PER # <br />PER # <br />PER # <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP -TE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR I MINOR <br />PERMIT TO OPERATE <br />12 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />122 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W43 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />_ <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />'� / <br />v/U OCC <br />A;_l <br />dam.Al <br />QNA 1S <br />b �cr <br />d <br />MAJOR MINOR 57 � NO <br />S 9� <br />j� <br />mphod .Z. SCC <br />4 <br />6S i- Gw <br />/b5cuet <br />VIOL VIOL. VIOL <br />LJ <br />N Or+ <br />O ar ele4oifs <br />OFFICE: <br />INSP: <br />II <br />RECEIVED BY: <br />TITLE: F4f S <br />PHONE: <br />RECK: <br />HUT -3 ORIGINAL 5/88 OM <br />