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? UNDERGROUN&TANK PROGRAM OFFICIAL INSP ION REPORT <br />WAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 G <br />PHONF N(1 AAA_ad9A COUNTY # > / <br />HUT -3 ORIGINAL 5/88 ©M <br />SITE NAME: /,� � <br />"� <br />�l " , <br />IN DATE:11415;1 <br />U <br />YAH <br />SITE ADDRESS:w^D� 'v, <br />� <br />CITY/,STATFIZI� <br />( <br />�� �f// <br />4 1 <br />CHANGES SITE/OWNER/PERMIiT'? <br />YES <br />NO <br />TANK <br />TANK <br />TANK <br />TANK <br />FORM A AND/ORB SUBMITTED? <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />PER # <br />PER # <br />PER # <br />PER # <br />EXP.DATE <br />EXP DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK <br />CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />—2 ---- <br />CHANGE <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 />_ <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />-- <br />ACCESS CASING SECURED <br />17 <br />18 <br />-- _- <br />PIPING <br />ig <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 />...._ <br />_....__ <br />APPROVED TANK REPAIRS <br />31 <br />- <br />32 <br />_ <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />--- <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING - <br />46 <br />49 <br />_.. _...._... <br />FLAMMABLE VAPORS REMOVED <br />50 <br />- - <br />" <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />-- - ` <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS <br />AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 59 <br />NO <br />MAJOL. ❑ MINORVIOL. ❑ ® <br />a-oex <br />VIVOL <br />�+ <br />OFFICE: <br />INSP: <br />W <br />ECEI D BY: <br />TITLE: <br />( <br />�/ <br />PHONE: <br />BECK: <br />HUT -3 ORIGINAL 5/88 ©M <br />