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UNDERGROU ' TANK PROGRAM OFFICIAL INSP ION REPORT <br /> WAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: S/--,Fo <br /> s <br /> SITE ADDRESS: /S3SS� CITY/STATE/ZIP - <br /> CHANGES SITE YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSP/ECTION O # # / PER# PER# PER# <br /> r 67 C4 EXP DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK rARK coN <br /> MAJOR MINOR - <br /> PERMIT TO OPERATE $34 <br /> CHANGE IN CONDITIONS TO OPERATE APPROVED CONSTRUCTION WRITTEN MONITORING PROCEDURES APPROVED MONITORING SYSTEM MONITORING SYSTEM APPROVED MONITOR FREQUENCY 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 FE 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 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 /> 310 MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FO OWS: �,fIJ Lt� (TS <br /> L <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> ERZ tle <br /> OFFICE: INS-P: /7�,� L2-z-- RECEIVED BY: <br /> TITLE: CJIi y1/ PHONE: RECK: <br /> TAUT-3 ORIGINAL siea OM <br />