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UNDERGROU10 TANK PROGRAM OFFICIAL INSTION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT" <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 COUNTY # <br /> COUNTY NAME CL (.(444- PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br /> vJ CztwC ` <br /> SITE ADDRESS: o�o� �Q � �1 Cya 1 __,> <br /> ���YV CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/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 INSPECTION SITE COMPUTER# PER# 1715-01 PER # PER # PER# <br /> / 7 _511 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 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 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 W4445 <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 -� <br /> 50 <br /> UNAUTHORIZED RELEASE 51 52 - - <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONSAND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: — <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL. .❑ VIOL.❑ -- -- -- <br /> OFFICE: INSP: ////��� RECE�I/JVED BY;, <br /> y y, :�'��'•J`-�"`�'"1..y�" I/� {'I n G,L,C.�l/-ten C 7/ � ___ <br /> TITLE: <br /> PHONE: /( RECK: <br /> 5/88 <br /> HLIT-3 ORIGINAL <br />