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UNDERGROUNQ TANK PROGRAM OFFICIAL INSPRCTION REPORT <br /> . SAN JOAQUIN HEALTH DISTRIC' <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME -jou I STOCKTON, CA 95205 Cl��r # <br /> PHONE NO. 468-3423 <br /> SITE NAME: l I + C 1� rh INSPECTION DATE: <br /> SITE ADDRESS: co l I LAD ` tal6n CITY/STATE/ZIP s+ <br /> CHANGES SITE/OWNER/PERMIT YES NO TANK Q ,' TANK O� TANK TANK <br /> FORM A AND/OR B SUBMITTED? k COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INNSPECTION SITE COMI � Iq NUMBER I I I 2) NUMBER (I 1 NUMBER NUMBER <br /> YLp I L V�VJa Il 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 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 3/ 32 _ <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 139 _ <br /> FLAMMABLE VAPORS REMOVED W44457 <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTED 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 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE rCORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: -r re 7 no,,�c S1 <br /> Cr <br /> MAJOR 57 58 MINOR NO r59 <br /> VIOL. ❑ VIOL ❑ VIOL.U <br /> OFFICE: INSFn. RECEIVED BY: <br /> TITLE: F-fl A•T. PHONE: RECK: <br /> HUT-3 ORIGINAL 5/m 0 <br />