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UNDERGROU16 TANK PROGRAM OFFICIAL INS�ON REPORT <br />SAN JOAQUIN HEALTH DISTRIC <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 cuoxri # <br />PmIMTV MSMF r�r.w K.0 468-3423 <br />VVVV, nVVr <br />SITE NAME: VQ 1 e /u� <br />f , <br />INSPECTION DATE: Z <br />SITE ADDRESS: Y <br />�/ f J ),, /� <br />CITY/STA E/ZIP �74 n <br />L� �saQ <br />b <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO TANK D <br />TANK d -P- TANK O <br />TANK 'D <br />FORM A AND/OR B'SUBMITTED? <br />COMPUTER <br />COMPUTER COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION SITE CO <br />PER # <br />PER # PER # <br />PER # <br />EXP. DATE <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />CONTENTSMIlNORR <br />AJ17IANK <br />MAJO <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />.... <br />UNAUTHORIZED RELEASE OCCURRENCE 27 <br />28 <br />_. <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />_ <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />64 <br />SAFETY HAZARD <br />35 <br />36 t✓ <br />__ t __ <br />_ _.. _. <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />_ <br />ACCESS LOCATIONS SEALED <br />V4445 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 1_. <br />PIPING <br />48 <br />49 <br />_.... _.. <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MLTST BE CORRECTED AS <br />SYSTEM STA7TUSS (MUST MARK ONE) <br />FOLLOWS:"' <br />58 <br />MAJOR 5 MINOR ❑ <br />59 <br />NO LJ6 <br />r <br />VIOL. LI VIOL. <br />VIOL <br />OFFICE: <br />INSP: <br />�`u Re S �. <br />RECEIVED B : Mr. S fcwt X20 o re_ <br />M&4 )e7to '. P, O. cq? <br />�saa <br />PHONE: <br />RECK: <br />TITLE' �.yG�`J <br />HUT -3 ORIGINAL 5/88 ©M <br />