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UNDERGROU19 TANK PROGRAM OFFICIAL INS TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: p� � S INSPECTION DATE: <br /> SITE ADDRESS: JJra ds .'L� !1 � CITY/STATE/ZIP <br /> CHANGES SITE/OWvNER/PERMIT? YES NO TANK O/ TANK 02. TANK /i 03 TANK ClORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER / <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER / NUMBER r NUMBER Ll/� NUMBER 5 y TV, <br /> PER # 7LL PER#-3 o,OS PER # 731f^� PER <br /> EXP.DATt EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR I 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 V4445 <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: 9 .8�- -P/y-� <br /> 57 58MAJO9 <br /> NO <br /> OL. ❑ VIOLL..R ❑ VOL.❑ <br /> OFFICE: INS RECEIVED BY: <br /> L <br /> � PHONE: BECK: <br /> HUT-3 ORIGINAL 5/86 O� <br />