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UNDERGROUISTANK PROGRAM OFFICIAL INS <br /> P�TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME ( �v a �,�yti, STOCKTNO. 46 95205 COUNTY # <br /> JU�i�I PHONE NO. 468-3423 <br /> SITE NAME: l i-� U ��Y INSPECTION DATE: �/o- P �di <br /> upe <br /> SITE ADDRESS: 07(O I(? Tee e `off /D CITY/STATE/ZIP 5k C�,r <br /> CHANGES SITE/OWNER/PERMIT? YES TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COM—P7UTER# PER# 1"-7,3V—t) PER# PER# PER# <br /> / EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK rANK CONTENTS MINOR <br /> INOR <br /> MAJOR MR <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 T <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 39 _ <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED --------- <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 /> 71 <br /> THE MARKED ITEMS REPRESENT VIOLATIQNS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: SG <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: RECEIVEDBY:_ / <br /> Q � � m -L (� (j <br /> TITLE: PHONE: RECK: <br /> 4UT-3 ORIGINAL rise ©M <br />