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UNDERGROUN- `ANK PROGRAM OFFICIAL INSPF'-'ON REPORT <br /> -..,,,.AN JOAQUIN HEALTH DISTRICT .� <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMEJ STOCKTON, CA 95205 COUNTY #J? <br /> PHONE NO. 468-3423 <br /> SITE NAME: ' /%��'� /a ca Ao 2'29�f{G INSPECTION DATE: .3 s1ga <br /> SITE ADDRESS: �- lQ35 CITY/STATE/ZIP G� (�i�r.�(c <br /> CHANGES SITE/OWN/ER/PERMIT? YES NO TANK TANK Z TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> J Prv'� EXP.DATE EXP.DATE EXP ATE EXP.D E <br /> OPERATIONAL TANK TANK CONTeNT5 <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 17 118 <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 33 134 <br /> SAFETY HAZARD 3536 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 4142 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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 CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: !l. V <br /> 57 58 59 sea-- <br /> MAJOR MINOR <br /> VIOL. ❑ VIOL ❑ VIOL❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: �Ets-/5 �T/✓/ PHONE: RECK: <br /> HUT-3 ORIGINAL sive O <br />