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UNDERGROU TANK PROGRAM OFFICIAL INSP ION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE.STOCKTON, CA 95205 3ry <br /> COUNTY NAME PHONE NO. 468-3423 <br /> COUNTY # 7 <br /> SITE NAME: G I SPECTION DATE: �Z7i <br /> L'7 <br /> SITE ADDRESS: 2t�73 <br /> CITY/STATE/ZIP I r� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK 7i TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPU R <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF IN PECTION�,-L SITE COMPUTER# PER# PER # PER # PER # <br /> �7 v"�I EXP.DATE EXP.DATE EXP_DATE EXP.DATE <br /> OPE ATIONAL TANK TANK CONnNT <br /> MAJOR MINOR <br /> PERMIT TO OPERATE <br /> CHANGE IN CONDITIONS TO OPERATE <br /> APPROVED CONSTRUCTION <br /> WRITTEN MONITORING PROCEDURES <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 112 1 <br /> APPROVED MONITOR FREQUENCY 13 114 <br /> MONITORING RECORDS MAINTAINED 15 116 1 <br /> ACCESS CASING SECURED 17 118 <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 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 W43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> 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) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO ,59 <br /> VIOL. L] VIOL. ❑ VIOL <br /> OFFICE: INSP. RECEIVED BY' <br /> TITLE: '��� PHONE: RECK: <br /> HUT-3 ORIGINAL 5/88 OM <br />