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UNDERGROUF') TANK PROGRAM OFFICIAL INSPr -TION REPORT <br /> i SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. _ <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: 2 p!7 5 AGI` CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK ?� TANK Z TANK 3 TANK Lj <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPU R <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# PER # PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONIENIS pp <br /> MAJOR I MINOR .H <br /> PERMIT TO OPERATE 1 12 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 1 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY :13:Z 14 k <br /> MONITORING RECORDS MAINTAINED 15 6 X <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 X X <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 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <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) FOLLOWS: <br /> 7 / VIOL. VIOLEI �� f z, <br /> MAJOR 5ry MINOR 58 NO <br /> VIOL. IJ <br /> O — <br /> OFFICE: INS` P: RECEIV BY: <br /> TITLE: PHONE: RECK: <br /> HUT-3 ORIGINAL siva O" <br />