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UNDERGROUITANK PROGRAM OFFICIAL INSP ION REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 COUNTY # <br />P811NTV WIMP c X11 nca_anoa <br />39 <br />HUT -3 ORIGINAL 5/88 v, <br />SITE NAME: <br />//LGtG,vNG <br />INSPECTION DAT <br />E���/ <br />SITE ADDRESS: <br />CITY/STATE/ZIP l? <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO <br />TANK <br />TANK Z <br />TANK <br />TANK <br />FORM AAND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />—COMPUTER <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />PER # <br />TYPE OF INSPECTION <br />SITE # <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TAN <br />MINOR <br />R <br />MAJOR OR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 _. _.. ... <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />..... _ - <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 _ <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />_. <br />TANK GAUGING <br />23 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 -- <br />-' .... <br />SAMPLING <br />29 <br />30_ <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />V,1, <br />37. <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38t43 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED - <br />41 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />44 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />--- <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />R <br />54 <br />._ <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE)S <br />FOLLOWS: % <br />/ <br />� S <br />57 58 <br />59 <br />MAJOR MINOR NO <br />❑ <br />VIOL. -❑ VIOL. VIOL <br />'2 <br />j74 - <br />OFFICE: <br />INSP: <br />RECEIVED BY: <br />TITLE: <br />PHONE: <br />BECK: <br />HUT -3 ORIGINAL 5/88 v, <br />