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UNDERGROjfD TANK PROGRAM OFFICIAL INFMCTION REPORT <br /> SAN JOAQUIN HEALTH DISTRI <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME4,Qj,._iif �, S INSPECTION DATE: <br /> SITE ADDRESS: c?v,6 `p� CITY/STATE/ZIP y� D` <br /> CHANGES SITE YES NO TANK / TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER�W� NUMBER NUMBER NUMBER <br /> TYPE�OF INSPECTION SITES COMPUTER# PER # d4C4�lIG PER# PER# PER# <br /> /�O � �'✓�C/ EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TANK <br /> OPERATIONAL TANK ----NI N 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 1 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING <br /> APPROVED RESPONSE PLAN <br /> UNAUTHORIZED RELEASE OCCURRENCE <br /> SAMPLING <br /> APPROVED TANK REPAIRS <br /> UNAUTHORIZED RELEASES REPORTED <br /> SAFETY HAZARD 351 <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL V4142 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <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 /> SA 53 54 <br /> IMPROPER NDONM 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: r <br /> MAJOR 57 MINOR 58 NO 59 - <br /> VIOL. VIOL. ❑ VIOL❑ <br /> OFFICE: INSP:jowG RECEIVED BY: <br /> TITLE: �,E�,s PHONE: O PECK: <br /> HUT-3 ORIGINAL 5/88 ©m <br />