Laserfiche WebLink
UNDERGROU�' TANK PROGRAM OFFICIAL INSP ^TION REPORT <br />WAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 <br />PHONE NO. 468-3423 COUNTY it <br />SITE NAME: <br />4 W14 / 52f�J <br />INSPECTION DATE: <br />�VC.< <br />ON <br />SITE ADDRESS: k-� O -T 5 <br />f <br />CITY/STATE/ZIP toe_ kms^ <br />CHANGES SITE YES <br />NO <br />TANK <br />i <br />TANK -Z <br />TANK 3 <br />TANK S <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />TYPE OF IN`S(PECTION - <br />SITE COMPUTER # <br />1(0(0 -7 <br />PER# <br />PER# <br />PER# <br />PER# <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK TANK CONTENTS <br />S50 <br />MAJOR MINOR 90J <br />/y� <br />io t�00 VL WV u. L <br />PERMIT TO OPERATE 1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE 3 <br />4 <br />APPROVED CONSTRUCTION 5 <br />6 <br />WRITTEN MONITORING PROCEDURES 7 <br />8 <br />APPROVED MONITORING SYSTEM 9 <br />10 <br />-� <br />MONITORING SYSTEM 11 <br />12 <br />APPROVED MONITOR FREQUENCY 13 <br />14 <br />..�. <br />MONITORING RECORDS MAINTAINED 15 <br />16 <br />ACCESS CASING SECURED 17 <br />18 <br />.. <br />.�-_. <br />PIPING 19 <br />20-' <br />INVENTORY RECONCILIATION 21 <br />22 <br />TANK GAUGING 23 <br />24 <br />APPROVED RESPONSE PLAN 25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE 27 <br />28 <br />' <br />SAMPLING 29 <br />30 <br />APPROVED TANK REPAIRS 31 <br />32 - <br />UNAUTHORIZED RELEASES REPORTED 33 <br />34� <br />SAFETY HAZARD 35 <br />36 <br />CONDITIONS ABATED <br />37 <br />I <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL 38 <br />39 <br />FLAMMABLE VAPORS REMOVED 40 <br />.__��... <br />ACCESS LOCATIONS SEALED 141 <br />142 <br />'. <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING 44 <br />45 <br />I <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS 46 <br />47 <br />I <br />PIPING - 48 <br />49--� <br />FLAMMABLE VAPORS REMOVED 50 <br />UNAUTHORIZED RELEASE 51 <br />52- <br />SAMPLING 53 <br />54 <br />IMPROPER ABANDONMENT 55 <br />56 <br />- <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />CG Z, <br />7 58 59 <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL. VIOL. VIOL. <br />OFFICE: <br />INSP:_ <br />ECEIV B <br />TITLE: /j <br />PHO RECK: <br />HUT -3 ORIGINAL 5188 OM <br />