Laserfiche WebLink
UNDERGROU TANK PROGRAM OFFICIAL INSP111I0N REPORT <br /> SAN JOAQUIN HEALTH DISTRICTW <br /> 0 1601 E. HAZELTON AVE. <br /> COUNTY NAME, STOCKTOCA 95205 COUNTY # _j <br /> [.G PHONE NO.O. CA 95 23 <br /> SITE NAME: LCI.GIh �n G INSPECTION DATE: f7 <br /> SITE ADDRESS: /D o CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK Q / TANK Q TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> PER# PER# PER # PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TMK CONreNTs <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 38 139 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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 COR TED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:,<-, <br /> 57 58 59 <br /> MAJOR lmo <br /> VIOL. LlVIOOR ❑ VOL.❑ <br /> OFFICE: IN P: yD ECEIVED BY: <br /> TITLE: P ONE: RECK: <br /> HUT-3 O GINAL 5/88 n' <br />