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UNDERGROUr ) TANK PROGRAM OFFICIAL INSf :TION REPORT <br />SAN JOAQUIN HEALTH DISTRICI--d <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKON, CA 96205 <br />PHONE TNO 468-3423 COUNTY # <br />SITE NAME:(D6ES�an/E <br />INSPECTION DATE: <br />SITE ADDRESS: /{aU E< 0OR44p <br />CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? <br />YES NO TANK *rr <br />TANK TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER COMPUTER COMPUTER <br />TYPE OF INSPECTION SITE COMPUTER # NUMBER <br />NUMBER NUMBER NUMBER <br />/tUt%riNE i3Rl D6 <br />PER # <br />40 <br />PER # PER # PER # <br />EXP. DATE <br />EXP. DATE EXP. DATE EXP. DATE <br />OPERATIONAL TANK1 <br />KCONTEN <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />- <br />WRITTEN MONITORING PROCEDURES <br />_77—/ <br />APPROVED <br />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />1 12 <br />APPROVED MONITOR FREQUENCY1 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />2P 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 4 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 42 <br />POWER DISCONNECTED <br />43 <br />7 <br />OWNER/OPERATOR MONITORING <br />44 45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 49�-�- <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />53 54 <br />IMPROPER ABANDONMENT <br />_ <br />55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 68 <br />59 <br />MAJOR MINOR❑NO <br />VIOL. VIOL VIOLLJ <br />OFFICE: <br />INSP:�,Q/L��Ey�� <br />RECEIVED BY: 7i7 <br />/fhb -3`f19 <br />TITLE: E• W-- S' <br />PHONE: <br />RECK: <br />HUT -3 ORIGINAL 51w O" <br />