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UNDERGROUl TANK PROGRAM OFFICIAL INSP TION REPORT <br /> - SAN JOAQUIN HEALTH DISTRICT - <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 .3 <br /> SITE NAME: ! INSPECTION DATE: 1'0-6—" <br /> SITE ADDRESS: !aO C�GLai� CITY/STATE/ZIP CWCn <br /> CHANGES SITE/OWNER/PERMIT? YES TANK at TANK C? TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER IVY C/ NUMBER /OY7-0 MBER NUMBER <br /> LPER# PER# PER# PER# <br /> Teak YBinOvci /()L/ -7 EXP DATE EXP.DATE EXP DATE EXP.DATE <br /> OPERATIONAL TANK TANK CON�NTs <br /> MAJOR I MINOR " <br /> PERMIT TO OPERATE 1 2 h <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 w�O aux <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 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 32 _ <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD 135 136 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W43 <br /> FLAMMABLE VAPORS REMOVED _ <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> 7 <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: T/Lnot .f— <br /> MAJOR 57 MINOR58 NO 59 f, — <br /> VIOL ❑ VIOL. ❑ VIOL LJ {L <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: n �O IseS PHONE: <br /> HUT-3 C+ ORIGINAL 5/W OM <br />