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UNDERGROUNr SANK PROGRAM OFFICIAL INSPE ON REPORT <br /> _AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 3`t <br /> PHONE NO. 468-3423 <br /> SITE NAME: r0 AM INSPECTION DATEZ Z rf G <br /> SITE ADDRESS: No �� Twp � CITY/STATE/ZIPSr�A/ <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK ANK 2, TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTECOMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER NUMBE�R /� NUMBER /0 UMBER NUMBER <br /> PER#(�M+6h�c">' PER# u�'1r��Q PER# PER# <br /> `& 7 EXP.DATE a 5 EXP.DATE ! f EXP.DATE EXP.DATE <br /> OPERATIONAL TANK 1AJ CONTENTS <br /> MAJOR I 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 2O <br /> INVENTORY RECONCILIATION 21 122 1 _ <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 - 26 <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 W142 <br /> FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED 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 153 154 <br /> IMPROPER ABANDONMENT 155 156 <br /> THE MARKED ITEMS REPRESE VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: Z` �� T S <br /> L <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. ❑ VIOL ❑ VIOL. A44 ? GP 41 oc- cG <br /> OFFICE: INSP: ,�✓ARECEIVED BY: <br /> TITLE:gf d5 PHONE: BECK: <br /> HUT-3 ORIGINAL sine ©M <br /> c <br />