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UNL)rllUKUUN'T IAINK PHL)U iAM OFFICIAL INSPF^TION REPORT <br /> ,,�AN JOAQUIN HEAQLTH DISTRIC1 <br /> COUNTY NAMEAu STOCKTON, CA 95205 COUNTS # <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: / <br /> SITE ADDRESS: /" S CITY/STATE/ZIP t6 <br /> CHANGES SITE/OWNLE/R/PERMIT? ,AS N TANK �y TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTER COMPUTER COMPUTER <br /> TYP OF INSPECPON SITE U # NUMBER NUMBER NUMBER NUMBER <br /> PER # PER # PER # PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANKTANK CONTENTS <br /> MAJOR 1 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 23 124 1 _ <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 W4445 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> 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 /> _- <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MAR TE S RE RESENT VIOLATIO S AN MUST BE ORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS' <br /> MAJOR 57 58 <br /> MINOR NO 5 <br /> VIOL. LJ VIOL. ❑ VIOL <br /> OFF INSP:, RECEIVED BY: <br /> TITLE:tl PHONE' BECK: <br /> -TUT-3 ORIGINAL 5/88 OM <br />