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UNDERGROUP TANK PROGRAM OFFICIAL INSPr7eTION REPORT <br />�<SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONF NO 4RR-'�49A <br />SITE NAME: ;5WM e U11� <br />e4GO179 <br />INSPECTION DATE: 3V,1-7147 <br />SITE ADDRESS: 13p N //VmT� <br />CITY/STATE/ZIP � <br />4 9 <br />CHANGES SITE/OWNER/PERMIT? <br />YES NO <br />TANK — o <br />TANK — v 2,. <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />TYpSpE OF INSPECTION <br />SITE COMPUTER # <br />/CD(iT]NC <br />LA�c/1� <br />I2 <br />PER # <br />PER # <br />PER # <br />PER # <br />7 <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />e <br />MAJOR MINOR <br />::.'v u^v v;...y`TtY:m <br />,*V, ra +'X <br />PERMIT TO OPERATE <br />1 2 <br />, <br />[e=.:;; <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 />1 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />-- <br />--- <br />-- <br />INVENTORY RECONCILIATION <br />22 <br />_ <br />f <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 />38 139 <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W44457 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />53 54 <br />IMPROPER ABANDONMENT <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUSiMUST MARK ONE) <br />FOLLOWS: <br />o <br />Sr 58 <br />MAJOR -y MINOR NO <br />LJ <br />Li <br />VIOL LJ VIOL. VIOL. <br />OFFICE: <br />INSP:�<< <br />V <br />RECEIVED BY: <br />TITLE: �, �- S <br />PHONE: <br />RECK: <br />HUT -3 ORIGINAL 5/m 0" <br />