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UNDERGROU <br />TANK PROGRAM OFFICIAL INSP TION REPORT <br />WAN HEAOITH DISTRICT <br />JOAQUIN <br />1601 E. AVE <br />STOCKTON, CA 95205 COUNTY # <br />COUNTY NAME <br />PHONE NO. 468-3423 <br />INSPECTION DATE:' <br />`" <br />SITE NAME: � / I_�T L� <br />c%� <br />C� I) CITY/STATE/ZIPn#PER <br />SITE ADDRESS: '� <br />TANK <br />coMPUJ <br />TANK <br />COMPUTERCOMPUTER <br />NUMBER <br />CHANGES SITE/OWNER/PERMIT? YES NO TANK <br />B SUBMITTED? GOMPE <br />FORM AAND/OR <br />NUMBS <br />NUMBE <br />TYPE OF INSPECTION <br />SITE COMPUTER#� PER <br /># Ll <br />PER # �� <br /># <br />/ EXP. <br />DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <br />- - - <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />- - <br />MONITORING SYSTEM <br />11 12 <br />- <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />- <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />-- <br />- -- <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />�- <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />-- <br />SAFETY HAZARD <br />35 36 <br />-...- <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />_ <br />ACCESS LOCATIONS SEALED <br />W4445 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />- <br />PIPING <br />48 49 <br />FLAMMABLE VAPORS REMOVED <br />50- <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />53 54 <br />- <br />IMPROPER ABANDONMENT <br />55 56 <br />THE MARKED ITEMS R PRESE VIOLATIONS AND MU,$T BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLL WS: r <br />`59 <br />MAJOR 57 MINOR 58 NO m <br />❑ L] VIOL <br />s <br />VIOL. VIOL. <br />OFFICE: INS P <br />RECFJVED BY: <br />. <br />TITLE: '-70 <br />PHON BECK: <br />5168 � <br />HUT -3 <br />ORIGINAL <br />