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UNDERGROU`TANK PROGRAM OFFICIAL INSP- /ION REPORT <br />,..AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 Comy # 3� <br />COUNTY NAME J Aw� PHONE NO 468-3423 <br />SITE NAME: /v <br />INSPECTION DATEe �S <br />S <br />SITE ADDRESS: r760 C 1 <br />/ <br />CITY/STATE/ZIP Lfj� l <br />CHANGES SITE/OWNER/PERMIT? YE'S7 <br />NIY <br />TANK <br />TANK <br />TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER (J/ <br />COMPUTER <br />COMPUTER COMPUTER <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUMBER NUMBER <br />PER # PER # <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE EXP. DATE <br />OPERATIONAL TANK TANK CONTENTS <br />MAJOR MINOR. <br />PERMIT TO OPERATE 1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE 3 <br />4 <br />APPROVED CONSTRUCTION 5 <br />6 <br />_ <br />WRITTEN MONITORING PROCEDURES 7 <br />8 <br />APPROVED MONITORING SYSTEM 9 <br />10 <br />_ <br />MONITORING SYSTEM 11 <br />12 <br />APPROVED MONITOR FREQUENCY 13 <br />14 <br />_ <br />MONITORING RECORDS MAINTAINED 15 <br />16 <br />ACCESS CASING SECURED 17 <br />118 <br />PIPING 19 <br />20 <br />INVENTORY RECONCILIATION 21 <br />122 <br />TANK GAUGING 23 <br />124 <br />APPROVED RESPONSE PLAN 25 <br />126 <br />1 <br />UNAUTHORIZED RELEASE OCCURRENCE 27 <br />28 <br />SAMPLING 29 <br />30 <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL 38 <br />139 <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W4445 <br />_ <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS 46 <br />47 <br />PIPING 48 <br />149 <br />FLAMMABLE VAPORS REMOVED 50 <br />UNAUTHORIZED RELEASE 51 <br />152 <br />SAMPLING 53 <br />154 <br />IMPROPER ABANDONMENT 55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS ND MUST BE C9RRECTED AS • /� <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />S B_7�j'�H��/_p•.�-L!� <br />57 <br />MAJOR 7MINOR 58 NO 5599/ <br />❑ <br />VIOL -jVIOL. MOLXJ <br />OFFICE: <br />INSP: A/. <br />RECEIVED BY: <br />C'` 4 <br />PHONE: <br />RECK: <br />TITLE: <br />HUT -3 ORIGINAL 51m O, <br />