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UNDERGROU ) TANK PROGRAM OFFICIAL INSP-';TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC•n <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 25 <br /> COUNTY NAME PHONE NO. 468 3423 COUNTY # <br /> SITE NAME: �' INSPECTION DATE: <br /> SITE ADDRESS: �J7 /NO fj� CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK O/ TANK !7Z- TANK O5 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER QL79d NUMBER 4�V NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK conn Nrs <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 15 116 1 _ <br /> ACCESS CASING SECURED 17 118 <br /> PIPING 19 120 1 _ <br /> INVENTORY RECONCILIATION 122 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 126 <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 VZIZ 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 4/ 42 <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING 44 45 <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 /> 53 54 <br /> ,IMPROTFER ABANDONM 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> S (MUST MARK ONE) FOLLOWS: � ` 'cy <br /> MAJOR 57 MINOR NO 58 LJ <br /> VIOL VIOL D VIOL <br /> OFFICE: INSPP, RECEIVED BY: <br /> liwl <br /> TITLE: 'e/J • PHONE:��033 BECK: <br /> HUT-3 ORIGINAL !� 5/m <br />