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UNDERGROUVTANK PROGRAM OFFICIAL INSPr. ON REPORT �y <br /> . AN JOAQUIN HEALTH DISTRICT..,' / / 6 G Z <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA PHONE NO. 468-3423 COUNTY # 3 <br /> SITE NAME: INSPECTION DATE: <br /> --7 6 <br /> SITE ADDRESS: �'�� <br /> � ( / CITY/STATE/ZIPly <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK TANK v/O TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER ! COMPUTER COMPUTER COMPUTER <br /> TVP OF INSP CTI SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# PER # PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <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 1q <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 <br /> APPROVED TANK REPAIRS Ti- 32 - <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD <br /> CONDITIONS ABATED 37 <br /> IVA <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED q0 -- <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED q3 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS46 47 <br /> PIPING qg *49FLAMMABLE VAPORS REMOVEDUNAUTHORIZED RELEASE 51 <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: Z <br /> MAJOR 57 58 <br /> MINOR NO 59 <br /> VIOL. ElVIOL ❑ VIOL <br /> OFFICE: INSP:� RECEIVED BY: <br /> TITLE,/4W PHONE: RECK: <br /> HUT-3 ORIGINAL 5/88 OM <br />