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UNDERGROUTANK PROGRAM OFFICIAL INSPE TION REPORT <br />VAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />RAM[ <br />STOCKTON, CA 95205 COUNTY # " <br />UUVnI I mm�� �� vu-[ u/N f-,.CAG1N1 <br />INSPECTION DATE: <br />SITE NAME: <br />cormaN s <br />SITE ADDRESS: <br />ro <br />CITY/STATE/ZIP <br />330 <br />CHANGES SITE/OWNER/PERMIT? <br />YE <br />NO <br />TANK ( <br />TANK 2 TANK <br />ANK <br />FORM AAND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER J�tb <br />COMPUTER COMPUTEROMPUTER <br />NUMBER NUMBERUMBER <br />I <br />TYPE OF INSPECTION SITE COMPO <br />ER # <br />PER # ✓ <br />PER # PER #ER <br /># <br />�ti RPyrw�(� /7 � <br />EXP. DATE <br />EXP. DATE EXP. DATEXP. <br />DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR <br />MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />-- <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />-- <br />-- <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />-.-- -. <br />..--- <br />PIPING <br />19 <br />20 <br />_ <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />--- <br />TANK GAUGING <br />23 <br />24 <br />-- <br />- <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />_ <br />_.-.___.... <br />-.. <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />-- <br />SAMPLING <br />- --- <br />- <br />APPROVED TANK REPAIRS <br />_ <br />_- <br />UNAUTHORIZED RELEASES REPORTED <br />331 <br />SAFETY HAZARD <br />__.. .... <br />..._.,____.. <br />CONDITIONS ABATED <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />--.—_---- <br />FLAMMABLE VAPORS REMOVED <br />40 <br />--.:-- <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING - <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />----------- <br />UNAUTHORIZED RELEASE <br />51 <br />52__.—. <br />----- <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MtRKONE) ffo (/o%r(iO+�S <br />'l'Aa <br />FOLLOWS: <br />ObSP/'VR��c.N� <br />57 58 <br />59 <br />MAJOR MINOR NO <br />VIOL. VIOL. VIOL. <br />OFFICE: <br />INSP: <br />/Jy� fi <br />RECEIVED BY: <br />C��ltS <br />j7 <br />TITLE: Elis <br />PHONE: <br />RECK <br />HUT -3 ORIGINAL siva OM <br />