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UNDERGROUq�TANK PROGRAM OFFICIAL INSP TION REPORT <br /> USAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMESTOCKTON, CA 95205 COUNTY # .3 �( <br /> PHONE NO. 468-3423 �7 <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: 7k50 50 Ow CITY/STATE/ZIP S/�'-,eh, (pq- ?54:�/© <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK O / 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 /> l A �3 PER# PER# PER# PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL fANK TANK CONTENT <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 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 U43 <br /> FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> 7 <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: <br /> 41 <br /> 57 58 59 <br /> MAJOR NO <br /> VIOL. ❑ VIIOLL..R ❑ VOL.❑ <br /> OFFICE: INSP: , ) IRECEIVED BY: <br /> TITLE: -i5jy C' PHONE: RECK: <br /> HUT-3 /7 )ORIIGINI/ALa.7 5/m OM <br />