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UNDERGROU " TANK PROGRAM OFFICIAL INSP TION REPORT <br /> WSAN JOAQUIN HEALTH DISTRICIW <br /> 1601 E. HAZLETON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> ti u/� PHONE NO. 468-3423 <br /> SITE NAME: & NC e INSPECTION DATE: 912y/97 <br /> SITE ADDRESS: 30017 LOv i�l CITY/STATE/ZIP S N c'4 q52'!q' - <br /> CHANGES SITE/OWNER/PERMIT. YE NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? j COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> PER # PER # PER # PER # <br /> / N EXP.DATE EXP.DATE EXP DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR I MINOR <br /> PERMIT TO OPERATE 12 <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 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 31 <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED VZI, 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 S <br /> SYSTEM STATUS(MUST MARK ONE) N8 VIP"O5 FOLLOWS: n d/5 r�.#' <br /> JSeAS cf OC.f r•7tiy 58 `jC ��ibr7 Sri 9�C <br /> MAJOR MINOR NO d r QA.e� 7 c+r - dN 665 <br /> VIOL. ❑ VIOL. ❑ VIOL.❑ p7„ PT '' <br /> OFFICE: INSP: C / RECEIVED BY: <br /> LIN <br /> TITLE: CHS PHONE: RECK: <br /> HUT-3 ORIGINAL 5/w OM <br />