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UNDERGROUI)&TANK PROGRAM OFFICIAL INSPWION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME_ STOCKTON, CA 95205 COUNTY # g <br /> Sc��- PHONE NO. 468-3423 <br /> SITE NAME A0 + - SPECTION DATE: <br /> SITE ADDRESS: 's // l- 1, 1 CITY/ST /ZIPS a c1q <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK TANK T NK <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTIO SITE COMPUTER# PER # PER# PER # PER # <br /> 1S EXP.DATEEXP,DATE EXP.DATE EXP.DATE <br /> OPERATIONA TANK TANK CONTENTS , e <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 r2 <br /> APPROVED MONITOR FREQUENCY 13 14 1 <br /> MONITORING RECORDS MAINTAINED 15 16 ,� ✓ 3 ! ��-� <br /> ACCESS CASING SECURED 17 18 <br /> PIPING <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 \t <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED _ <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <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 /> 57 58 59 <br /> MAJOR NO <br /> VIOL. ❑ VIOLL..R ❑ VOL.❑ <br /> OFFICE: INSP: ECEIVED BY: <br /> TITLE-��/foJQ" PHONE: BECK <br /> HUT-3 ORIGINAL <br />