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UNDERGROU TANK PROGRAM OFFICIAL INSP ION REPORT <br /> AN JOAQUIN HEALTH DISTRICT (� <br /> 1601 E. HAZELTON AVE. �} <br /> COUNTY NAME �J CT 2 STOCKTON, CA 95205 COUNTY # <br /> 3 ( J ( �� PHONE NO. 468-3423 <br /> SITE NAME: 5 ,T. 6/L /G INSPECTION DATE: y <br /> D !� <br /> SITE ADDRESS: Z7lij / 1AV4CITY/STATE/ZIP 5 <br /> 7�y����� p5 � <br /> CHANGES SITE/OWNER/PERMIT? YES NO ANK y TANK qTANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMB NUMBER L10OOfO NUMBER NUMBER <br /> TYPE OF IN PECTION SITE COMPUTER# �OOO <br /> _ PER # PER # G/us PER# PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK —I s <br /> MAJOR MINOR <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 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 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD - 35 36 <br /> CONDITIONS ABATED 37VA <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <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: -d <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. LN VIOL LlVIOL.❑ <br /> OFFICE: INSP: CE Y: <br /> TITLE: VS P NE: BECK: <br /> NUT-3 ORIGINAL <br />