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UNDERGROUV- TANK PROGRAM OFFICIAL INSPF'TION REPORT <br /> `SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME S J STOCKTON, CA 95205 COUNTY # .{Q <br /> /� / PHONE NO. 468-3423 - J / <br /> SITE NAME: C 15 I v✓�U INSPECTION DATE: <br /> P <br /> SITE ADDRESS: /DD5 FAj M,5nCITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK ® f TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMP ER COMPUTER <br /> TY E OF INSPCT SITE COMPUTER# NUMBER NUMBER NUM R NUMB R <br /> PER# PER # PE # PER <br /> v L � EXP.DATE EXP.DATE E .DATE EX .DATE <br /> OPERATIONAL TANK LINK CONTENTS <br /> MAJOR .,.�` . - <br /> L <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 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 &r7 <br /> FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REM 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 VIOLATION§AND MUST B CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 59 <br /> ' r v <br /> MAJOR MINOR 58 NO <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: �, ��- J PHONE: PECK: <br /> HUT-3 ORIGINAL siae ©m <br />