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UNDERGROU' TANK PROGRAM OFFICIAL INSF ;TION REPORT <br /> - SAN JOAQUIN HEALTH DISTRICT`" <br /> 1601 E. HAZELTON AVE. q <br /> COUNTY NAME -c�tv jozLSTOCKTON, CA 95205 COUNTY # 3 I <br /> ILA— PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE:CJS Jz (y <br /> SITE ADDRESS: ' l�3 wu CITY/STATE/ZIP 5 r� <br /> &K 1 /q ` J a� 7o <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK p I TANK 07- TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER t� NUMBER _ NUMBER NUMBER <br /> TYPE OF INSPECTION <br /> - D SITE COMPUTER# PER# OZ';'✓ PER # 01;t PER# PER# <br /> f <br /> 1 �C/, ;), 5 t� EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR I 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 v/ <br /> INVENTORY RECONCILIATION 21 122 <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 <br /> SAFETY HAZARD 35 36 J <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 13. 139 _ <br /> FLAMMABLE VAPORS REMOVED W43 <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 50mm <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRYED AS <br /> SYSTEM STATUS(MUST MARK ONE) y FOL LO CJI <br /> 58 <br /> MAJOR 57 MINOR NO 69 /�� ct ed <br /> VIOL ❑ VIOL ❑ VIOL❑ o <br /> OFFICE: INS,P4 RECEIWD BY. <br /> T=: ftNE: RECK: <br /> r <br /> HUT-3 ORI NAL Slee OM <br />