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UNDERGROUIiTANK PROGRAM OFFICIAL INSPWION REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. V " S <br />STOCKTON, CA 95205 COUNTY # 3 / <br />COUNTY NAME NE NO 468-3423 <br />� <br />PHO <br />SITE NAME: 4"� <br />INSPECTION DATE: 9/a % <br />S j <br />SITE ADDRESS: 1111 SS <br />U); t404 <br />CITY/STATE/ZIP S f , 611- 0 <br />7 <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO <br />TANK Q / <br />TANK 07- TANK TANK <br />FORM AAND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER COMPUTER COMPUTER <br />NUMBER NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION SITE COMPUTER <br />PER # <br />PER # PER # PER # <br />f## <br />r piwl-fT1/a-Q. A 3 a <br />EXP. DATE' <br />EXP. DATE EXP DATE EXP DATE <br />TANK <br />CONTENTS <br />* h.;. `ter, <br />OPERATIONAL TANK <br />MAJOR MINOR <br />PERMIT TO OPERATE 1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE 3 <br />4 <br />APPROVED CONSTRUCTION 5 <br />6_ <br />WRITTEN MONITORING PROCEDURES 7 <br />8 <br />APPROVED MONITORING SYSTEM 9 <br />10 <br />MONITORING SYSTEM 11 <br />12 <br />- <br />APPROVED MONITOR FREQUENCY 13 <br />14 <br />MONITORING RECORDS MAINTAINED 15 <br />16 <br />ACCESS CASING SECURED 17 <br />18 <br />PIPING 19 <br />20 <br />q�.... _pq <br />_ <br />QAC} <br />40 - <br />-0 <br />INVENTORY RECONCILIATION 21 <br />INVENTORY <br />22 <br />_ <br />TANK GAUGING 23 <br />24 <br />APPROVED RESPONSE PLAN 25 <br />26 <br />_ _ - <br />UNAUTHORIZEDRELEASEOCCURRENCE 27 <br />28 <br />SAMPLING 29 <br />30 <br />APPROVED TANK REPAIRS 31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED 33 <br />34 <br />SAFETY HAZARD 35 <br />36 <br />_._.. <br />-. <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />39 <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED W4142 <br />POWER DISCONNECTED <br />43OWNER/OPERATOR <br />MONITORING <br />45� <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS 46 <br />47 <br />__ _..... <br />PIPING 48 <br />49 <br />- <br />FLAMMABLE VAPORS REMOVED 5002 <br />- <br />UNAUTHORIZED RELEASE 51 <br />52 <br />✓ <br />._._.. <br />SAMPLING 53 <br />54 <br />IMPROPER ABANDONMENT 55 <br />56 <br />THE MARKED <br />ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 59 <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL. VIOL. VIOL. <br />OFFICE: <br />RECEIVED BY: <br />TIT E <br />IDHONE: <br />BECK: <br />HUT -3 ORDINAL Sena vm <br />