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UNDERGROUND TANK PROGRAM OFFICIAL INSPECTION REPORT <br />4AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON,CA 95205 <br />PHONE NO 468-3423 COUNTY # j9 <br />SITE NAME: e6le <br />INSPECTION DATE: <br />SITE ADDRESS: 7S' <br />��T G�j✓F �� ITY/STATE/ZIP <br />7` 7 f <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO TANK ( <br />TANK <br />TANK T/CNK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER 'COMPUTER <br />TYPE OF INSPECTTII�ON� SITE <br />NUMBER /_ 0 <br />NUMBER <br />NUMBER NQ7MBER <br />� � � �CJOMPUTEFI <br />S/ <br />�,' <br />�`��'�''� ` <br />EXP. DATE <br />EXP. DATE <br />EXP. DATER. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR <br />MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />116 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />- <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />135 <br />36 <br />CONDITIONS ABATED <br />- ---- <br />VZZZ 37VA <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W43 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />t. <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />, <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />MAJOR 57 MINOR NO <br />❑ ❑ <br />69 <br />VIOL. VIOL VIOL <br />OFFICE: <br />INSP: <br />v✓ <br />RECEIVED BY: <br />TITLE: j �/ <br />PHONE: <br />BECK: <br />HUT -3 ORIGINAL . "R� 0' <br />