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UNDERGROUi TANK PROGRAM OFFICIAL INSP TION REPORT <br /> - SAN JOAQUIN HEALTH DISTRICT`' <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: 17- 11 INSPECTION DATE:3 <br /> SITE ADDRESS: G�SL�Ne CITY/STATE/ZIP-7 °fS 3 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER / COMPUTER COMPUI COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION / I <br /> SITE COMPUTER# PER# PER# PER# PER# <br /> – <br /> �'"W/e /C(i{...�nPq.(y� l7 O -/ EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK 7ANK COWEN1S <br /> MAJOR MINOR <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 13 114 <br /> MONITORING RECORDS MAINTAINED - <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 120 1 <br /> INVENTORY RECONCILIATION 21 122 <br /> TANK GAUGING 23 124 1 <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 Fff 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 139 <br /> FLAMMABLE VAPORS REMOVED W43 <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> 7 <br /> PERMANENT TANK CLOSURE re w =n <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: ef h O/J <br /> 57 58 59 <br /> lv"U <br /> VIOLOR LJ VIOLOR MINE] VIOL❑NO <br /> �t <br /> s <br /> 2 S'S <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> HUT-3 ORIGINAL siae Om <br />