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UNDERGROUr -rANK PROGRAM OFFICIAL INSPF TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME J STOCKTON, CA 95205 COUNTY # 3� <br /> PHONE NO. 468-3423 <br /> SITE NAME: NeW S 'Sr e{ INSPECTION DATE: 616 <br /> SITE ADDRESS: O S CITY/STATE/ZIP.f C <br /> / QC <br /> CHANGES SITE/OWNER/PERMIT?CyEV NO TANK pT TANK O TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMP R# NUMBER NUMBER NUMBER NUMBER <br /> / EXP.DATE EXP.DATE PER# �� EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TAR.coNTEN15 <br /> MAJOR MINOR •-MF <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 17 118 <br /> PIPING 19 120 1 <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 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL IqA 139 <br /> FLAMMABLE VAPORS REMOVED W4445 <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 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) O d(OI LFI <br /> LOWS: �^� 2 s"O (eaYl exCOKrnON <br /> / <br /> MAJOR S 2 <br /> GG�SC/Y/crt deli•'} 59 NOR ❑ NO IV <br /> VIOL. VIOL VIOL <br /> OFFICE: INSP:e Alm RECEIVED BY: <br /> TITLE: E- S• ` PHONE: HECK: <br /> HUT-3 ORIGINAL <br />