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UNDERGRO D TANK PROGRAM OFFICIAL INS CTION REPORT <br /> SAN JOAQUIN HEALTH DISTRI <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: /' � u it 76 INSPECTION DATE 53 <br /> SITE ADDRESS: l'f�l v 7•'AV- ��t n CITY/STATE/ZIP c S <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK 3 TANK y TANK $ TANK G <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF I SPECTIION SITE COMPUTER# PER # PER# PER# PER# <br /> mt'lb OIC EXP.DATE EXP.DATE EXP.DATE EXP. DATE <br /> OPERATIONAL TANK TANK CONnNTS <br /> MAJOR MINOR /Z DOD 2 Ofi1v' ooeD S� L✓. <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 HAZARD35 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 BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 58 <br /> MAJOR 57 MINOR NO 59 <br /> VIOL. VIOL. ElVIOL.❑ <br /> OFFICE: INSP- ! RECEIVED Y: <br /> TITLE: /J C PHONE: RECK: <br /> - <br /> NUT-3 ORIGINAL siea OM <br />