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UNDERGROU' TANK PROGRAM OFFICIAL INSP ,TION REPORT <br />_ SAN JOAQUIN HEALTH DISTRIC.,w <br />1601 E. HAZELTON AVE. <br />C01.116Y NAME STOCKTON, CA 95205PHONE NO 4" 3423 COUNTY # �i 7 <br />HUT -3 ORIGINAL 8/88 O' <br />SITE NAME: L- r -o" <br />,1 w <br />INSPECTION DATE: /, 2—Z q <br />SITE ADDRESS: i? /_ <br />/� �, �� i,� <br />l <br />CITY/STATE/ZIP �--L 9J 3f <br />/ l / <br />,1 <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO <br />TANK ' <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBE p d d <br />COMPUTER <br />NUMBER <br />COMPUTE <br />NUMBER <br />COMPUTER <br />NUMBER <br />TYP OF INSP CTION <br />SITE COMPUTER # <br />O H (N o <br />VG �/ <br />PER # (%/L. <br />PER # <br />PER # <br />PER # <br />EXP. DATE- <br />EXP.DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK TAN <br />CONTEWS <br />MAJOR MINOR <br />PERMIT TO OPERATE 1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE 3 <br />4 <br />APPROVED CONSTRUCTION 5 <br />6 <br />_. <br />WRITTEN MONITORING PROCEDURES 7 <br />8 <br />APPROVED MONITORING SYSTEM 9 <br />10 <br />MONITORING SYSTEM 11 <br />12 <br />APPROVED MONITOR FREQUENCY 13 <br />14 <br />MONITORING RECORDS MAINTAINED 15 <br />16 <br />_ <br />ACCESS CASING SECURED 17 <br />18 <br />PIPING 19 <br />20 <br />�( <br />INVENTORY RECONCILIATION 21 <br />22 <br />_ / ` <br />-- <br />TANK GAUGING 23 <br />24 <br />APPROVED RESPONSE PLAN 25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE 27 <br />28 <br />SAMPLING 29 <br />130 <br />_ <br />APPROVED TANK REPAIRS 31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED 33 <br />34 <br />SAFETY HAZARD 35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />"_ <br />REMOVAL OF RESIDUAL 1 <br />139 <br />FLAMMABLE VAPORS REMOVED 40 <br />ACCESS LOCATIONS SEALED 41r42POWER <br />DISCONNECTED <br />OWNER/OPERATOR MONITORING 44 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS 46 <br />47 <br />PIPING 48 <br />49 <br />FLAMMABLE VAPORS REMOVED 50 <br />UNAUTHORIZED RELEASE 51 <br />52 <br />_ <br />SAMPLING 53 <br />54 <br />IMPROPER ABANDONMENT 55 <br />56 <br />_ <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />Z p G Z <br />57 58 59 <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL. VIOL. VIOL <br />of <br />OFFICE: <br />INSP: <br />REC <br />ED BY: <br />TITLES <br />r1 <br />PHONE: <br />RECK: <br />HUT -3 ORIGINAL 8/88 O' <br />