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UNDERGROU ' TANK PROGRAM OFFICIAL INSPU^TION REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />/ STOCKTON, CA 95205 <br />COUNTY NAME n a� <br />7O., r /10OiA1/� PHONE NO. 468-3423 COUNTY #J / <br />SITE NAME: <br />INSPECTION DATE: 2/z%0 <br />N <br />0 <br />SITE ADDRES <br />Obi <br />R� <br />CITY/STATE/ZIP <br />/'T°�)c C,� 9531 <br />CHANGES SITE <br />/OWNER//PERMIT? <br />YES NO <br />TANK <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR <br />B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />TYPE OF INSPECT <br />ON <br />SITE COMPUTER�j/i7# <br />/ <br />Aom4l,� e <br />/N(9C <br />( <br />EXP. DATE <br />EXP. DATE <br />EXP DATE <br />EXP. DATE <br />OPERATIONAL, <br />TANK <br />TANK CONTENTS <br />MAJOR NOR <br />PERMIT TO OPER <br />NTE <br />1 2 <br />CHANGE IN GONE <br />BIONS TO OPERATE <br />3 4 <br />APPROVED CONE <br />TRUCTION <br />5 6 <br />WRITTEN MONITC <br />RING PROCEDURES <br />7 8 <br />APPROVED MON[ <br />ORING SYSTEM <br />9 10 <br />MONITORING BYE <br />EM <br />11 12 <br />APPROVED MONI <br />OR FREQUENCY <br />13 14 <br />MONITORING RE <br />ORDS MAINTAINED <br />15 16 <br />ACCESS CASING <br />SECURED <br />17 18 <br />PIPING <br />19 20 <br />_ <br />_ <br />INVENTORY REG <br />NCILIATION <br />21 2 <br />TANK GAUGING <br />23 24 <br />APPROVED RESP <br />DNSE PLAN <br />25 26 <br />UNAUTHORIZED I <br />ELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 30 <br />APPROVED TANK <br />REPAIRS <br />31 32 <br />UNAUTHORIZED I <br />ELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />3536 <br />CONDITIONS AB <br />ED <br />37 <br />TEMPORARY <br />TANK CLOSURE <br />REMOVAL OF RE <br />(DUAL <br />FLAMMABLE VAPORS <br />REMOVED <br />ACCESS LOCATI <br />NS SEALED <br />W43 <br />POWER DISCON <br />CTED <br />OWNER/OPERAT <br />R MONITORING <br />PERMANE <br />4T TANK CLOSURE <br />REMOVAL OF RE <br />lIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 49 <br />_ <br />FLAMMABLE VAPORS <br />REMOVED <br />50ME <br />UNAUTHORIZED I <br />tELEASE <br />51 52 <br />SAMPLING <br />53 64 <br />IMPROPER ABANDONMENT <br />55 56 <br />AUST. MARK ONE) <br />THE MARKED ITEMS <br />FOLLOWS: <br />REPRESENT VIOLATIONS <br />AND MUST BE CORRECTED AS <br />SYSTEM STATUS (I <br />57 <br />58 <br />59 <br />MAJOR <br />MINOR NO <br />❑ <br />❑ <br />VIOL. <br />VIOL. VIOL <br />OFFICE: <br />INSP: <br />RECEIVED BY: <br />TITLE: <br />PNE �- <br />BECK: <br />HUT -3 I ORIGINAL 5/88 OM <br />