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UNDERGROUl'n TANK PROGRAM OFFICIAL INSPECTION REPORT <br />_ SAN JOAQUIN HEALTH DISTRIC-, , <br />1601 E. HAZELTON AVE. ""- <br />COUNTY NAME STOCKTON,CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: <br />INSPECTION DATE:��� <br />SITE ADDRESS: QD g' S <br />G���E <br />CITY/STATE/ZIP��� T <br />CHANGES SITE/OWWNER/PERMIT? <br />YES NO TANK O <br />TANK TANK <br />ANK <br />FORM AAND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER COMPUTER <br />COMPUTER <br />NUMBER <br />NUMBER NUMBER <br />NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # <br />PER # <br />E�t4FP/�%!N!i(I �2 Q �jJ <br />PER # PER # <br />PER # <br />EXP. DATE <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR I MINOR <br />PERMIT TO -OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 120 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPUNG <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD35 <br />36 <br />CONDITIONS ABATED <br />37 <br />_ <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />1 139 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />_ <br />41 r45 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />44 <br />PERMANENT TANK CLOSURE <br />MM <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />53 54 <br />IMPROPER ABANDONMENT <br />_ <br />55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />kn6eL+�'�lGr+��'E��� S� <br />FOLLOWS: <br />2iY Edlo.�l � r3 <br />MAJOR 57 MINOR 58 NO <br />❑ LlVIOL <br />59 �- <br />L!! / <br />VIOL. VIOL <br />OFFICE:J4- <br />ECEI D BY: <br />TITLE: •N. S <br />NE��6�-0333 <br />RECK <br />HUT -3 ORIGINAL B/BB em <br />