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UNDERGROU TANK PROGRAM OFFICIAL INSP TION REPORT <br />WSAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAMEj STOCKTON,CA 95205 COUNTY # 3q <br />[�QNI,(LiGL/,!/L�J PHONE NO. 468-3423 <br />SITE NAME: / R&E <br />S <br />INSPECTION DATE: <br />[[[ <br />SITE ADDRESS:: gq 8-� <br />CITY/STATE/ZIP V; (Jfpr C/ <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />O <br />NK O / <br />T\EP. <br />TANK O �.. <br />TANK 0,3 <br />TANK � �6 <br />FORM A AND/OR B SUBMITTED? <br />MPUTER <br />OMPUTER <br />OMPUTER <br />OMPUTER <br />MBER <br />R# <br />UMBER <br />P R# <br />UMBER <br />P R # <br />UMBER <br />R# <br />TYPE OF INSPECTION Q <br />YYLDV <br />SITE COMPUTER # <br />3 O <br />"(/�- <br />DATE <br />E .DATE <br />E . DATE <br />E P. DATE <br />OPERATIONAL TANK <br />TANK CONTEN S <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <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 />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />r <br />n r <br />r. <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />13' 5 <br />3/ 5/ U 3/j / Q <br />3/ Q <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38t43 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />44 <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 />UNAUTHORIZED RELEASE <br />51 <br />52 <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 MARK ONE) <br />FOLLOWS: <br />57 68 <br />59 <br />MAJOR NO <br />❑ ❑ <br />❑ <br />VIOLL..R <br />VIOL. VIOL. <br />OFFICE: <br />INSP„�SoO�}�Y'_. <br />RECEIVED BY: <br />a <br />TITL(E/:J�iGG)ti"XK <br />-e— <br />PHONE: <br />BECK: <br />4 <br />HUT -3 &RIGINAL 5/88 OM <br />