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UNDERGRWD TANK PROGRAM OFFICIAL INS ECTION REPORT <br /> SAN JOAQUIN HEALTH DISTRj <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br /> / L llsfi� <br /> SITE ADDRESS: /�— CITY/STATE/ZIP <br /> C<ti/ <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# "o� PER # PER # PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <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 i <br /> MONITORING RECORDS MAINTAINED 15 16a - <br /> ACCESS CASING SECURED 17 18 t-�— <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION Ti— 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 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> 9 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 2 <br /> POWER DISCONNECTED 3 <br /> OWNER/OPERATOR MONITORING <br /> RMANENT TANK CLO RE <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 /> T ARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:. zitzlk /S <br /> 58 <br /> MAJOR 57 MINOR NO 59 <br /> ce <br /> rf <br /> VIOL ❑ VIOL ❑ VIOL. H <br /> OFFICE: INSP: 14F01 OZ RECEIVED BY: <br /> TITLERE�S PHONE�i f 3�� RECK: <br /> HUT-3 ORIGINAL {{�� �/ 5/88 ©M <br />