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UNDERGROUP'- TANK PROGRAM OFFICIAL INSPF-TION REPORT <br /> >r AN JOAQUIN HEALTH DISTRICT.! <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 3(� <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: 11//6($e <br /> SITE ADDRESS: 1/IQ NL CITY/STATE/ZIP / g51� n <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK 1* 3 TANK TANK TANK (� <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER # <br /> RCIM OvCt l EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MAJOROR MINOR] <br /> INOOR*AIMR <br /> - <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 12 777 7 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 116 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <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 131 132 1 _ <br /> UNAUTHORIZED RELEASES REPORTED 133 134 1 _ <br /> SAFETY HAZARD 135 136 <br /> CONDITIONS ABATED 37 VA <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 _ <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED M 43 1 <br /> OWNER/OPERATOR MONITORING 44 45 <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 /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: O 1 -APA a`^,," <br /> 57 58 59 4,Lk <br /> NO <br /> VIOL. ❑ VIOLL..R ❑ VIOL❑ �` <br /> a�5 . <br /> OFFICE: INSP:C ff �S '! RECEIVED BY: <br /> 1..�'IU('K �/A.N <br /> TITLE: PHONE: RECK: <br /> HUT-3 ORIGINAL s/e O <br />