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UNDERGROUI TANK PROGRAM OFFICIAL INSPF TION REPORT <br />`SAN JOAQUIN HEALTH DISTRICT 6,--/ <br />1601 E. HAZELTON AVE. <br />COUNTY NAMESTOCKTON, CA 95205 COUNTY #3 <br />PHONE NO. 468-3423 cl <br />SITE NAME: INSPECTION DATE: ZO <br />SITE ADDRESS: 7�CR� 7� c CITY/STATE/ZIP �S <br />CHANGES SITE YES NO TANK TANK TANK TANK <br />FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br />TYPE OF INSPECTION SITE COMPUTER # NUMBER NUMBER NUMBER NUMBER <br />PER # PER # PER # Y IPER# <br />-KE ig O V A L -- <br />OPERATIONAL TANK <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />SYSTEM STATUS (MUST MARK ONE) <br />TANK CONTENTS <br />MAJOR MINOR <br />1 2 <br />3 4 <br />5 6 <br />7 8 <br />9 10 <br />11 12 <br />13 14 <br />15 16 <br />17 18 <br />19 20 <br />21 22 <br />23 24 <br />25 26 <br />27 28 <br />29 30 <br />31 32 <br />33 34 <br />35 36 <br />/1 37 <br />A <br />71 ` f♦ <br />f <br />39 <br />N <br />42 �- <br />43 <br />44645 <br />s <br />I MAJOR Li MINOR 0 NO <br />VIOL. VIOL. VIOL. <br />THE MARKED ITEMS T VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: REP ESEN— — — <br />OFFICE: INSP <br />: RECEIVED BY: <br />Z�_'�C-x / -, v�y <br />TITLE: T:�76-,14.5. PHONE - <br />HUT -3 ORIGINAL <br />BECK: <br />