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UNDERGROUITANK PROGRAM OFFICIAL INSP�TION REPORT <br /> AN JOAOUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME � STOCKTON, CA 95205 COUNTY # <br /> sQ/Yl ori PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: �3 Q <br /> SITE ADDRESS: C�pl�� 5-f- CITY/STATE/ZIPe�/ `�-tad? <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK p TANK ( ( TANK N TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTE COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSP CTION SITE COcMPLITER# PER# PER# PER # PER# <br /> r [ EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERA A <br /> tTMKCOPERMIT TO OPERATE CHANGE IN CONDITIONS TO OPERATE APPROVED CONSTRUCTION -WRITTEN MONITORING PROCEDURES <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 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 135 136 1 .. _ <br /> CONDITIONS ABATED 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 - <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 /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: G <br /> i <br /> MAJOR <br /> 57 MINOR 58 NO 59 <br /> VIOL. ❑ VIOL. VIOL.❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: PECK: <br /> siea O N <br /> f1RIrINAi <br />