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UNDERGROUlf TANK PROGRAM OFFICIAL INSTION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC <br /> r 1601 E. HAZELTON AVE. <br /> COUNTY NAME 3(, r, �C2 STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: , D e , `� �'x G INSPECTION DATE: 3C <br /> SITE ADDRESS: ' �1CITY/STATE/ZIP S f <br /> CHANGES SITE/OWNER/PERMIT? Y NO TANK O TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# / 7a 1L/ PER # PER# PER# <br /> �CR y EXP.DATE FXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK coNTeNTs ` <br /> MAJOR MINOR ti <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 15 116 _ <br /> ACCESS CASING SECURED 17 118 <br /> PIPING 19 20 <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 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W444�1 <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 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 4 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 5�-L- MINOR Ll VI L <br /> VIOL. I� VIOL. VIOL. <br /> OFFICE: INSP: �0-71-y. v 19' <br /> EB1'r <br /> /��•a-�-'L aS 5`an lir... .b. 5:17 <br /> CL41— <br /> TITLE: •`� pj� P O 6( bt L <br /> Mr uXIS�= siva ©M <br /> HUT-3 ORIGINAL <br />