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UNDERGROUNI'SANK PROGRAM OFFICIAL INSPE(WN REPORT <br />N JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME I STOCKTON, CA 95205 <br />n' i PHnNF Kin naa_ano� COUNTY # a <br />HU ( -3 ORIGINAL 5/88 OM <br />SITE NAME:/? <br />('1v �)a ftT7 <br />/ <br />INSPECTION DATE: <br />D A <br />11 2s5 <br />SITE ADDRESS: 0?3G A/ <br />/�W y ! / <br />CITY/STATE/ZIP <br />tgC"'ti"oo <br />CHANGES SITE/OWNER/PERMIT? <br />YES NO <br />TANK <br />TANK .2 <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />_3 <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE GOJv1PUTF,Ei �6 <br />/ <br />PER # <br />PER # <br />PER # <br />PER # <br />EXP_DAT_F <br />EXP. DATE <br />EXP. DATE <br />EXP DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />- <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <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 />137 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />_. <br />_. ._....... _. <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />- <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 />- <br />CONDITIONS ABATED <br />37 <br />----"- <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />&44t45 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />_.—.... <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 F44-77— <br />7PIPING <br />PIPING <br />48 49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />_ <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />!E 54 <br />- <br />-- --_. <br />IMPROPER ABANDONMENT <br />55 56 <br />THE MARKED ITEMS REPR ENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STA (MUST MARK ONE) <br />FOLLOWS: <br />Vol- <br />5[� 58 <br />59 <br />MAJOR7T/US <br />MINOR NO <br />VIOL. LSF-- <br />El— <br />VIOL VIOL <br />OFFICE: <br />INSP: <br />qC <br />RECEIVED BY: <br />TITLE:o/ S. <br />PHONE: <br />RECK: <br />HU ( -3 ORIGINAL 5/88 OM <br />