Laserfiche WebLink
UNDERGROUbTANK PROGRAM OFFICIAL INSP�TION REPORT <br /> AN JOAQUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 PHONE NO. 468-3423 <br /> COUNTY # <br /> SITE NAME: r INSPECTION DATE: <br /> SITE ADDRESS: y co 7 L.i a 1-� 1pp CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TTANK Z TANK 3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER <br /> PER# <br /> EXP.DATE <br /> NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# <br /> d 6 ( 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 .� ✓ '� <br /> MONITORING RECORDS MAINTAINED 15 116 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 120 1 ✓� <br /> INVENTORY RECONCILIATION21 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 RESIDUAL38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 141 142 <br /> POWER DISCONNECTED rXZX1XA 43 1 1 - <br /> OWNER/OPERATOR MONITORING 144 146 <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 r__... <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 58 59 <br /> MAJOR MINOR NO <br /> 57 <br /> VIOL. VIOL. 0 VIOL.1-1 <br /> OFFICE: INSP: RECEIVED BY: <br /> �CC � <br /> TITLE: PHONE: BECK: <br /> HUT-3 ORIGINAL 5/M O <br />