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UNDERGROUM' TANK PROGRAM OFFICIAL INSPF"TION REPORT <br /> ,.,.SAN JOAQUIN HEALTH DISTRICT / Z U f <br /> 1601 E. HAZELTON AVE. / 06 <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAMEN (AGPl UtH„ hex W INSPECTION DATE: 4-P -Sq <br /> SITE ADDRESS: Lf/s E / ' r S�r( (�G�'7 CITY/STATE/ZIP 19,S 3 7 C <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK 1 TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE C101jQPUTER# NUMBER NUMBER NUMBER NUMBER <br /> !, l I q1 PER# PER# PER# PER # <br /> W V` q EXP.DATE EXP_DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CON NT <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 /> 'UTHORIZED RELEASES REPORTED 33 34 <br /> S!ETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <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 REPRES NT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 59 <br /> NO - <br /> VIOL ❑ VIOL ❑ VIOL <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: /2FffS PHONE: RECK: <br /> HUT-3 ORIGINAL Sias 0 <br />