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UNDERGROUN- TANK PROGRAM OFFICIAL INSPF-TION REPORT <br />-.oAN JOAQUIN HEALTH DISTRICT'./ <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PPnNF Mn ARu_'lAO' <br />SITE NAME: SAhd �-50'4IW "'fJ C'q. <br />INSPECTION DATE: <br />iGf� <br />vv L <br />SITE ADDRESS: 113a <br />CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? <br />YES NO <br />TANK - <br />0 1 TANK — a Z <br />TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER COMPUTER <br />TYPE OF INSPECTION SITE COMPUTER # <br />NUMBER <br />NUMBER <br />NUMBER NUMBER <br />�fU�/N �1 �–�- <br />/� v <br />z7 <br />PER # <br />PER # <br />PER # PER # <br />J JJ <br />EXP_ DATE <br />EXP. DATE <br />EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR I MINOR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />3 14 <br />_ <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />, <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 120 <br />-- <br />INVENTORY RECONCILIATION <br />22 <br />TANK GAUGING <br />23-. 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />7 <br />ACCESS LOCATIONS SEALED <br />41 42 <br />- <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 45 <br />1 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 49 <br />-. - <br />.. <br />- .. .. _ _. <br />FLAMMABLE VAPORS REMOVED <br />50 <br />77 <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />53 54 <br />IMPROPER ABANDONMENT56 <br />V <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />S' -e 1AA 6 �= Z <br />MAJOR 57 MINOR 58 NO <br />❑ <br />59 <br />❑ <br />VIOL LTJ VIOL. VIOL <br />OFFICE: <br />INSP: <br />RECEIVED BY: <br />TITLE: �, ��, <br />�j <br />PHONE: <br />BECK: <br />HUT -3 OWNER'S COPY Slee ©. <br />