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UNDERGROUTANK PROGRAM OFFICIAL INSPIPTION REPORT <br /> VAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> Co . TOCKTON, CA 95205 COUNTY #,,3 <br /> COUNTY NAME <br /> Sa A,l V a Co • PHONE NO. 468-3423 <br /> SITE NAME: S{Jvvt:e� (!�oTT INSPECTION DATE: gaY g p <br /> SITE ADDRESS: ,0(1 �. �� E//i. CITY/STATE/ZIP S�j�,l c� q5P <br /> CHANGES SITE/OWN /PERMIT? YES NO TANK TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTIONSITE COM <br /> PUTER <br /> /# PER # PER# PER# PER# <br /> ,,,� <br /> r,�yuTv•'1 Z { A (O EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK MAJOR <br /> MINNOTS R <br /> MAJOR MR <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 tW, <br /> MONITORING RECORDS MAINTAINED 15 ACCESS CASING SECURED 17 PIPING 19 INVENTORY RECONCILIATION 21 TANK GAUGING 23 APPROVED RESPONSE PLAN 25 UNAUTHORIZED RELEASE OCCURRENCE 27 SAMPLING 29 APPROVED TANK REPAIRS 31 UNAUTHORIZED RELEASES REPORTED 33 SAFETY HAZARD 35 CONDITIONS ABATED 3 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL U443 <br /> 9 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 2 _ <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING 5 <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: <br /> 57 58 59 <br /> NO <br /> p OR ❑ VIIOLO.R ❑ VOL.❑ • v • r_-_ <br /> LL <br /> OFFICE- 17� !� 0tua,9& <br /> TIT ONE: RECK: <br /> 14 Rti <br /> HUT-3 ORIGINAL "' C <br />