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UNDERGROUND TANK PROGRAM OFFICIAL INSPEr `ION REPORT <br /> AN JOAQUIN HEALTH DISTRICT �� <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # j <br /> PHONE NO. 468-3423 q <br /> SITE NAME: r- La v &N-ToSTS aF,` ewj INSPECTION DATES <br /> SITE ADDRESS: 1 b 3 E' ' J � CITY/STATE/ZIP 44- 9J 37 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTEFj� , / COMPUT COMPUTER per_ COMPUTER <br /> NUMBER {J(/ NUMBERk., NUMBER �/�'�"" NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER g / v <br /> `/ PER#DA OpQ PER# VC.1 PER#DATA PER# <br /> b EXP.dAT EXP.DAT p EXP.DA 0 EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <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 15 116 <br /> ACCESS CASING SECURED 17 118 <br /> PIPING 19 120 <br /> INVENTORY RECONCILIATION 21 122 <br /> TANK GAUGING 23 124 <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 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL I 38 139 <br /> FLAMMABLE VAPORS REMOVED W142 <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> 7 <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) FOLLOWS: <br /> 57 58 59 <br /> VIOL. ❑ VIOLL ❑ VIOL.® 7 Pifv C <br /> _ tti <br /> OFFICE: INSF / REC ED BY: <br /> / TITLEE`'� PH BECK: <br /> HUT-3 ,GINAL siea O <br />