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UNDERGROUP TANK PROGRAM OFFICIAL INSPr- -TION REPORT <br /> - SAN JOAQUIN HEALTH DISTRICT- <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMESTOCKTON, CA 95205 COUNTY # <br /> :�'�°/✓� ()Cz PHONE NO. 468-3423 <br /> SITE NAME: , oeAL-� Fig reg Of' Rno cLtcc f g INSPECTION DATE: ,2 <br /> SITE ADDRESS: �oZ oZ Gr p� Gcr�e CITY/STATE/ZIP ��Y�d>7 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK Q TANK TANK TANK 4W- <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE <br /> pO,FINSPECTION SITE COMPUTER# PER# 4 3&0 PER# PER# PER# <br /> f v7Yw r (o D EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MNKR°r <br /> MAJOR MMINOR <br /> _ INOR <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 L37 <br /> MONITORING RECORDS MAINTAINED <br /> ACCESS CASING SECURED <br /> PIPING <br /> INVENTORY RECONCILIATION RECONCILIATION _ <br /> TANK GAUGING _ <br /> APPROVED RESPONSE PLAN <br /> UNAUTHORIZED RELEASE OCCURRENCE _ <br /> SAMPLING <br /> APPROVED TANK REPAIRS _ <br /> UNAUTHORIZED RELEASES REPORTED <br /> SAFETY HAZARD <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> 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 REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) •�� <br /> FO LOWS: <br /> 57 56 59 <br /> NO Ta <br /> VIOLOR ❑ VIOLIvillmVIOL❑ VOL❑ <br /> Zo- <br /> OFFICE: INSP:Aro, � RECEIVED BY: <br /> Lid hv'^^L� <br /> TITLE: PHONE: RECK: <br /> HUT-3 ORIGINAL sig ©M <br />