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UNDERGROUND TANK PROGRAM OFFICIAL INSPEr-TION REPORT <br />SAN JOAOUIN�HEAQLNTH DISTRICT ,w1601 E. H 1, <br />STOCKTON, CA 95205�+ <br />.OUNTY NAME `c, . 1I0 !N PHONE NO. 468-3423 <br />��i # <br />SITE NAME: Joe <br />INSPECTION DATE: <br />O <br />SITE ADDRESS: 71 3 /7 E <br />&MIpj2 <br />CITY/STATE/ZIP <br />[oCt CA <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />ANK <br />TANK <br />TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER COMPUTER <br />NUMBER <br />PER # 23 (9'000 f <br />NUMBER <br />PER # <br />NUMBER NUMBER <br />PER # PER # <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />='P�K'q(�Nt ON <br />i.31 1 <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />TANK COWENTS <br />MAJOR MINOR ... <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />_ <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />126 1 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 _ <br />SAMPLING <br />29 <br />30 _ <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 _ <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W4445 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 (/ <br />_ <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS:4 <br />1 .V O'f Qf�eG -tor 0a+cir4ra�t Scan Lnr <br />57 56 <br />❑ ❑ <br />p59MAJOR� <br />OL. VIOLL VIOL <br />f0L <br />OFFICE: <br />INSP-C6r4eS f6„ -t- <br />RECEIVED BY: <br />TITLE: <br />PHONE: <br />RECK: <br />HUT -3 ORIGINAL 5/w 0 <br />