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UNDERGROU*ANK PROGRAM OFFICIAL INSPE#ION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 <br /> PHONE NO. 468-3423 COUNTY #3"7 <br /> SITE NAME: INSPECTION DATE:�(//�� <br /> SITE ADDRESS.S"rd CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK O/ TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED?���_ COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYP OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> 3 P3 PER# PER # PER # PER # <br /> EXP. DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <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 <br /> APPROVED MONITORING SYSTEM 9 10 ---- <br /> MONITORING SYSTEM <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 - <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 <br /> INVENTORY RECONCILIATION 21 22 - <br /> TANK GAUGING 23 24 - -- - <br /> APPROVED RESPONSE PLAN 25 26 - <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 - <br /> SAMPLING 29 30 --- - <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED EE:3i7 M - _--- - <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> -- <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED - <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 __-...._... ... <br /> FLAMMABLE VAPORS REMOVED 50 M - <br /> UNAUTHORIZED RELEASE 51 52 - <br /> SAMPLING `- - <br /> 53 54 _ <br /> IMPROPER ABANDONMENT 55 56 - - <br /> THE MARKED ITEMSLREPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:MAJOR Ok.fi <br /> OL. ❑ VIOL.R El VIOL.NO J1p <br /> OFF/I�CE: INSP: n D RECEIVED BY: <br /> TITLE:K��J PHONE BECK: <br /> HUT-3 ORIGINAL <br /> sisa O <br />