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TANK PROGRAM OFFICIAL <br /> INSQW <br /> UNDERGROLIM <br /> SAN JOAOUIN HEALTH D STRICIW REPORT <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 COUNTY # <br /> COUNTY NAME PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: Z,VZZ/g/ <br /> 11 4 So�j �C. <br /> SITE ADDRESS: 17zl5 <A �_p ST - CITY/STATE/ZIP L5-4LON <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# PER# PER# PER# <br /> (/X4_ EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> NTENTS <br /> OPERATIONAL TANK TANK R MINOR <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 N314 <br /> MONITORING RECORDS MAINTAINED _ .. <br /> ACCESS CASING SECURED <br /> PIPING -�- _ <br /> INVENTORY RECONCILIATION TANK GAUGING APPROVED RESPONSE PLAN UNAUTHORIZED RELEASE OCCURRENCE SAMPLING APPROVED TANK REPAIRS UNAUTHORIZED RELEASES REPORTED SAFETY HAZARD CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL R4445 <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 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> Heep c L <br /> 57 56 59 �rd,41S.E T T a <br /> MAJOR MINOR NO <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP: RECEIVED BY: <br /> L�i icr�— 7?—PVP`. <br /> TITLE: PHONE: RECK: <br /> spas ©1 <br /> HUT-3 ORIGINAL <br />