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UNDERGROU' TANK PROGRAM OFFICIAL INSF TION REPORT <br /> - SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: o i/ jLC,_Sa'-_L4j� INSPECTION DATE:3 <br /> / -3 <br /> SITE ADDRESS: �� CITY/STATE/ZIP <br /> Ln ki-67. <br /> CHANGES SITE/OWNER/PERMIT? YES O' TANK d TANK TANK ITANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTIONSITE CO^^MPU//TER# PER# PER# PER# PER# <br /> 4- d(..N� EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK mNK coNreNTs <br /> MAJOR MINOR <br /> PERMIT TO OPERATE T56 CHANGE IN CONDITIONS TO OPERATE APPROVED CONSTRUCTION WRITTEN MONITORING PROCEDURES APPROVED MONITORING SYSTEM <br /> MONITORING SYSTEM 11 2 <br /> APPROVED MONITOR FREQUENCY 13 4 <br /> MONITORING RECORDS MAINTAINED 15 <br /> ACCESS CASING SECURED 17 18 1 1 <br /> PIPING 19 20 <br /> INVENTORY RECONCIUATION 21 22 _ <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPUNG 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 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 /> SAMPUNG 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: <br /> MAJOR MINOR NO 0 <br /> 57 58 <br /> VIOL. VIOL. 0 VIOL <br /> OFFICE: INSP: ^ , RECEIVED BY: <br /> LTJ <br /> TITLE:G _ _V.rrAC< PH n� RECK: <br /> HUT-3 ,�y'/ORIGINAL siva OM <br />