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UNDERGROUP" TANK PROGRAM OFFICIAL INSPF TION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> ' 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP 15W-`^- <br /> CHANGES SITE YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYP�OF IN PECTIONSITE COMPUTER# <br /> pi J� PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MN R <br /> MAJORJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 i. <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM L\ 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 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD <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 /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 _ <br /> MABLE 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) <br /> FOLLOWS: <br /> MAJOR 57 MINOR N NO 59 P <br /> VIOL. ❑ VIOL. L1A VIOL❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> '' G/bfs- 3 % tab' <br /> TITLE: PHONE: BECK: <br /> HUT-3 OWNER'S COPY sise ©M <br />