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UNDERGRC`Jr' TANK PROGRAM OFFICIAL INS `C TION REPORT <br /> y,,iAN JOAQUIN HEALTH DISTRIbr...r <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 <br /> PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: �o rr 5 c �h INSPECTION DATE: <br /> .sem 91 <br /> arr S/� G <br /> SITE ADDRESS: 2 3 87 y c:5� CITY/STATE/ IP _ <br /> 64 <br /> CHANGES SITE YES NO TANK TANK v r G TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SIT # NUMBER NUMBER NUMBER NUMBER <br /> PER# 7" 0 PER# PER# PER# <br /> A"4/;L4 I EXP.DATE- EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK <br /> MAJOR MINOR _ <br /> PERMIT TO OPERATE 1 <br /> CHANGE IN CONDITIONS TO OPERATE 3 V 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 V7 12 <br /> APPROVED MONITOR FREQUENCY 13 V 14 y <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <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 M37 <br /> SAFETY HAZARDCONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> s <br /> REMOVAL OF RESIDUAL W43 <br /> FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE - <br /> r <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: r <br /> O <br /> 58 59 v <br /> MAJOR 57 MINOR NO O'P o� rz r ✓rc G rO HS <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INSP: Ciro/ p� RECEIVED BY: <br /> TITLE: PHONE: PECK: <br /> HUT-3 ORIGINAL vea O <br />