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UNDERGROUNf' TANK PROGRAM OFFICIAL INSPE`ION REPORT <br /> ,,AN JOAQUIN HEALTH DISTRICT , <br /> 1601 E. HAZELTON AVE. Q 'LOU�1 39 <br /> CSUNTY NAME STOCKTON, CA 95205 I(a ' cover # / <br /> PHONE NO. 468-3423 <br /> SITE NAME: Kl d L s 7�UG� S,� INSPECTION DATE: �7 <br /> SITE ADDRESS: CITY/STATE/ZIP r�s`376 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK s TANK G TANK 7 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TuaCONTEWM <br /> MAJOR MINOR > <br /> PERMIT TO OPERATE -LX 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 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 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED _ <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> 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 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: D F <br /> 57 58 59 <br /> MAJOR NO <br /> Li <br /> VIOL LiVIOL.❑ <br /> OFFICE: INS P R EIVED BY, <br /> "tN <br /> TITLE: XA*,& PHONE: BECK <br /> HUT-3 ORIGINAL G <br />