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UNDERGROU TANK PROGRAM OFFICIAL INSTION REPORT <br />SAN JOAQUIN HEALTH DISTRICW <br />1601 E. HAZELTON AVE. <br />COUNTY NAME fct jqOQ c STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: <br />INSPECTION DATE: ll ;2/ <br />SITE ADDRESS: `, O D /-7 <br />� z --z- R� <br />CITY/STATE/ZIP '5�/4M <br />CHANGES SITE YES <br />NO <br />TANK p ( <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />D <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TYPE OF INSPECTION <br />n <br />/ <br />SITE COMPUTER # <br />/ / O <br />OPERATIONAL TANK <br />TANK <br />INTEN R <br />R MINOR <br />MAJOR 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 />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />_. <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />_ <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />r. <br />,_ <br />ACCESS CASING SECURED <br />17 <br />18 <br />1 <br />�h <br />_. <br />PIPING <br />19 <br />20 <br />__ <br />/ <br />.. <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />_ <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE 27 <br />28 <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 />95 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38r43 <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 />..... <br />PIPING <br />48 <br />49 <br />_. <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />511---52 <br />I/ <br />_ <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 <br />69 <br />MAJOR MINOR <br />NO <br />Ll <br />VIOL. VIOL. <br />VIOL. <br />OFFICE: <br />INSPP: <br />RECEIVED BY: <br />TITLE: <br />PHONE: <br />BECK: <br />Ups <br />HUT -3 OR(GINAL 6/88 <br />