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UNDERGROUND TANK PROGRAM OFFICIAL INSPEC—'ON REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> -�/ 1601 E. HAZELTON AVE. - <br /> COWY NAME STOCKTON, CA 95205 COUNTY # 3 <br /> PHONE NO. 468-3423 <br /> SITE NAME: L L�l� ��Gwt r( �j�/ INSPECTION DATE: —/3—� <br /> SITE ADDRESS: L ` (A� ,ems -SP�ITY/STATE/ZIP ojt: d7�5-3-76 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF IN CTIO ,,/ SRE COMPfU7TER# NUMBER 100 NUMBER NUMBER NUMBER <br /> /'e /1 3 EXP.DATE D1 eSG EXP.DATE PER# PER PER <br /> DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR 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 T <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 ZO _ <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 128 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD35 36 _ <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL I 38 139 <br /> FLAMMABLE VAPORS REMOVED W43 <br /> ACCESS LOCATIONS SEALED 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 <br /> AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO II�59I _ <br /> VIOL ❑ VIOL ❑ VIOL IBJ ijnaAZ /�' o,C -/ <br /> OFFICE: INSP: RCE ED BY: <br /> TITLE: PHONE: RECK: <br /> HUT-3 ORIGINAL siea Om <br />