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UNDERGROUIWTANK PROGRAM OFFICIAL INSR ION REPORT <br /> AN JOAOUIN HEALTH DISTRICT <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:�� � lalk, <br /> _ <br /> CHANGES SITE/OWNER/PERMIT? S NO TANK _ TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? �� _ COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF I SPECTION SITE COMPUTER# NUMBER ,n, NUMBER NUMBER NUMBER <br /> zt� 2-3 � z__ PER# / CJJ�� PER # PER # PER# <br /> EXP.DATE EXP.DATE EXP.DATE FXP_DATE <br /> OPERATIONAL TANK TANK CONTENTS r f <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 4 <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 3 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 mm <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED ME 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 BE CORRECTED AS <br /> SYSTEM STATUS tMUST MARK ONE) FOLLOWS: <br /> 59 <br /> MAJOR 57 MINOR o NO <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INS P f �la ECEIVED BY: <br /> TITLE: r, '5• ONE; BECK: <br /> �iUT-3 ORIGINAL see O+ <br />