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UNDERGROUP" TANK PROGRAM OFFICIAL INSPF" TION REPORT <br /> .SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNT NAME STOCKTNO-CA COUNTY #2 <br /> 3p(L PHONE NO. 468-3423-3423 <br /> SITE NAME: ��G. INSPECTION DATE: —/—9 3 <br /> SITE ADDRESS: Sf C�vuo �cz.u� CITY/STATE/ZIP s fOC Kms,c15� Asa <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / CEAST TANK a es TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # PER# PER# PER# <br /> EXP.DATE EXP.DATEp EXP.DATE EXP.DATE <br /> OPERATIONAL TANK m KCONIENI t) /0) C� <br /> MAJOR MINOR J <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 V <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 38 r43 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING 44 <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: a' <br /> 57 58 59 <br /> VIOL. LJVIOLO.R ❑ VIOL❑ <br /> OFFICE: ECEIVED BY- <br /> 6 <br /> Y: <br /> � O <br /> C:TITLE:Sp-Ni D'v <br /> HUT-3 ORIGINAL sig ©' <br />