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UNDERGROUWbTANK PROGRAM OFFICIAL INSPdVION REPORT <br /> MRSAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMESTOCKTON, CA 95205 COUNTY # 3 <br /> Sa,-, donuim PHONE NO. 468-3423 <br /> SITE NAME: Co gAj={ -7�f qt Ior-rs INSPECTION DATE: <br /> SITE ADDRESS. CITY/STATE/ZIP 5 <br /> >ak7i G4 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK 3TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBEFt70/�p NUMBER q NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# Wlerf-p PER# J ___Q PER # PER# <br /> EXP.DATE EXP.DATE rrss��cc EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TARKcoRnRrs <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 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 3132 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL P43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 %7n <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VI LATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) �. 61,ola o.-i ' FOLLOWS: <br /> ObsbY/a�dur, rfN <br /> 57 1 588 <br /> 59 <br /> MINNO <br /> VIOLOR ❑ VIOLL..R ❑ VIOL[j <br /> OFFICE: INSP: O� RECEIVED BY: <br /> TITLE: HSS PHONE: RECK: <br /> HUT-3 ORIGINAL siea O <br />