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UNDERGROUI TANK PROGRAM OFFICIAL INSPF-'TION REPORT <br /> '-'SAN JOAQUIN HEALTH DISTRICT=J <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME [[ � STOCKTON, CA 95205 COUNTY # 39 <br /> JLZM, �QQ PHONE NO. 468-3423 <br /> SITE NAME: S -*f 55- INSPECTION DATE: <br /> SITE ADDRESS: 3 70 <br /> I-flajX4,WIL, k)o�' CITY/STATE/ZIPsf pt KT�7 J� (f 7�� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK p/ TANK Q;I, TANK 03 TANK 4n SL <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTE <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OFI SQECTION SITE COMPUTER# PER# PER# PER# PER# <br /> �L-e� EXP.DATE- EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK T K CON ENI <br /> MAJOVI MINOR <br /> PERMIT TO OPERATE 1 V 12 <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 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 W43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> 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 CORRECTED AS <br /> SYSTEM STATUS IMUST MARK ONE) FOLLOWS: <br /> MAJOR 57 <br /> 7MINOR 58 NO 59 <br /> VIOL. Eq' VIOL ElVIOL LJ <br /> OFFICE: INSP: RECENED BY: <br /> TITLE: R F PHOW BECK: <br /> HUT-3 ORIGINAL siee O <br /> HU I-3 UKIGINAL "°� <br />