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UNDERGROUIP TANK PROGRAM OFFICIAL INSP TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. ., <br /> COUNTY NAIVESTOCKTON, CA 95205 COUNTY # 1 <br /> ham- /J PHONE NO. 468-3423 <br /> SITE NAME: ` ,f,L INSPECTION DATE: <br /> SITE ADDRESS: Z10 t ✓ CITY/STATE/ZIP C'� <br /> CHANGES SITE/OWNER/PERMIT? YES TANK <br /> o/ TANK 02 TANK 07 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> T)TF OF INSPECTION SITE COM LITER# pER# PER# ?BDL' PER# ( PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTEN-rs <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 <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 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 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BRRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP42V <br /> RECEIVED BY: <br /> TITLES PHONE: REGK: <br /> HUT-3 ORIGINAL <br />