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UNDERGROUP TANK PROGRAM OFFICIAL INSPI 'TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT - <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMES \ STOCKTNO. CA 95205 COUNTY #3 <br /> N PHONE NO. 468-3423 <br /> SITE NAME: 9- INSPECTION DATE: <br /> SITE ADDRESS: '1 S, e_ r n CITY/STATE/ZIP <br /> T � <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> _ FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUT R5 <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER!5IJP? U•L- NUMBER �Crr, NUMBER (f L. NUMBER µ19✓54 <br /> PER# PER# PER# PER# «L <br /> O EXP DATE EXP DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TIWK CONRe <br /> MAJOR I 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 _ <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 33 134 1 _ <br /> SAFETY HAZARD 35 3671 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 3839 <br /> FLAMMABLE VAPORS REMOVED 140 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <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 /> 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) 0$:1FOLLOWS: L <br /> MAJOR 58 <br /> � MINOR ❑ .1 [ <br /> VIOL. VIOL VIOL. <br /> OFFICE: [NSL: 6y X _ / RECEIVED BY: <br /> E�NS /U�Y PHONE: BECK: <br /> HUT-3 ORIGINAL siae O, <br />