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UNDERGROUTANK PROGRAM OFFICIAL INS�TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> n PHONE NO. 468-3423 <br /> SITE NAME: C ' L� mor INSPECTION DATE: <br /> SITE ADDRESS: 14 CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? NO TANK 3 TANKTANK $ TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTERY COMPUTER COMPU <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYP F INSPECTION SITE COMPUTE # PER # PER # PER# PER# <br /> (B(,/ v / EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATION L TANK <br /> TANK CONTENTS QO� Q UG l e0a �jrPH / ( �L o �✓ a' <br /> MAJOR MINOR IC <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 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 m _,_ <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 m <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 /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL ❑ VIOL. ❑ VIO <br /> OFFICE: INSL Pte.' �EEq D E <br /> (Xl 1 <br /> TITLE: � /�s PHONE: BECK: <br /> HUT-3 ORIGINAL siea OM <br />