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UNDERGRCOD TANK PROGRAM OFFICIAL INCTION REPORT <br /> SAN JOAQUIN HEALTH DISTRI <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: /moi/ �� ��f^ CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK 'a TANK-v` TANK TA <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER/4=4!> NUMBER/0004) NUMBER $j Ala NUMBER <br /> TYPE OF. INSPECTION SITE COMPUTER# PER # PER# PER # PER# <br /> 16-s/ EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> T78 <br /> _ <br /> PERMIT TO OPERATE <br /> CHANGE IN CONDITIONS TO OPERATE <br /> APPROVED CONSTRUCTION _ <br /> WRITTEN MONITORING PROCEDURES APPROVED MONITORING SYSTEM MONITORING SYSTEM <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 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 /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL. ❑ VIOL. LiVIOL. <br /> OFFICE: INSP RECEIVED BY: <br /> TITLE: PHONE: i!o_ 03 j RECK: <br /> -IUT-3 ORIGINAL <br />