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UNDERGROU► TANK PROGRAM OFFICIAL INSP' TION REPORT <br /> USAN JOAQUIN HEALTH DISTRICT,-,;, <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAK SoM STOCKTON, CA 95205 Cj <br /> PHONE NO. 468-3423 COUNTY # / <br /> SITE NAME: �i_ c� INSPECTION DATE: y/a y�9 <br /> SITE ADDRESS: / 6 J ��E+ CITY/STATE/ZIP <br /> CHANGES SITE/OWNER//PERMIT? YES NO TANK o/ TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE INS ECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> „�i a 3 1 PER# PER# PER# PER# <br /> C/�IA�T� EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK coNrE ' <br /> MAJOR MINOR - <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 jAPPROVED CONSTRUCTION 5 WRITTEN MONITORING PROCEDURES 7 APPROVED MONITORING SYSTEM 9 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 - <br /> ACCESS CASING SECURED 17 118 <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 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 55V 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 Z <br /> V L7 <br /> MINOR Lj NO El <br /> VIOL. VIOL. VIOL <br /> OFFICE: INSP: - /•„ REB 8Y: <br /> Piu"�`v Pah ;c/Cs Moor Service. <br /> TITLE: '"O'f& <br /> c e+tm/ �} <br /> HUT-3 ORI INAL 7F M7 <br /> e / GA, 5/m OM <br />