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' UNDERGRO D TANK PROGRAM OFFICIAL INS CTION 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: INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> Sly � o h l<o CNUMBER <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK UR <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTE TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER PER# PER #EXP.DATE EXP.DATE OPERATIONAL TANK TANK CONTENTS 4 MAJOR MINOR -�uY1k3 u�1ky (ANb �(ANf <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 e5ef ��. 25 �•y� l.�ti'. <br /> APPROVED MONITORING SYSTEM 9 10 Vtb ✓ v 0 _�. <br /> MONITORING SYSTEM 11 12 � " �(� J 1 �V}0 <br /> APPROVED MONITOR FREQUENCY 13 14 to alesJU L IOU <br /> MONITORING RECORDS MAINTAINED 15 16 Q'(XLE to, <br /> ACCESS CASING SECURED 17 18 1 <br /> PIPING 19 20 -� <br /> INVENTORY RECONCILIATION 21 22 0 / <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 1' <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 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESEN VIOLATIONS AND M ST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: h G7 <br /> s <br /> 58 K� <br /> MAJOR 57 MINOR ❑ NO <br /> i. VIOL. VIOL. VIOL <br /> El <br /> OFFICE: INSP: RECEIVED BY• <br /> Z g2 <br /> TITLE: Irl'�- Wl 5 PHONE: BECK: <br /> HUT-3 ORIGINAL siss OM <br />