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UNDERGROUN*NK PROGRAM OFFICIAL INSPE N REPORT f <br />SAN JOAQUIN HEALTH DISTRICT' 2 <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME:INSPECTION DATE c� b <br />C, <br />SITE ADDRESS: � � � <br />CHANGES SITE/OWNER/PERMIT? YES <br />FORM RAND/OR B SUBMITTED? <br />moi, f+N 1 <br />NO TANK <br />COMPUTER <br />NUMBER <br />j TY/STATE <br />TANK <br />COMPUTER <br />NUMBER <br />APf C <br />TAN <br />COMPUTER <br />NUMBER <br />j 3 - (j <br />TANK <br />COMPUTE <br />NUMBER <br />TYP OF INSPECTION <br />tt oli-LV <br />SITE COMUT# <br />(J � <br />7 8 <br />DER # <br />EXP. DATE <br />PER # <br />EXP. DATE <br />42 <br />PER # <br />EXP. DATE <br />PER # <br />EXP. DATE <br />13 14 <br />OWNER/OPERATOR MONITORING <br />TANK CONTENTS <br />45 <br />- <br />- <br />19 20 <br />.... <br />OPERATIONAL TANK <br />PERMIT TO OPERATE1 <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />AOR M NOR <br />REMOVAL OF RESIDUAL <br />�' 2 <br />39 _ <br />3 4 <br />5 6 <br />7 8 <br />ACCESS LOCATIONS SEALED <br />9 10 <br />42 <br />11 12 <br />13 14 <br />OWNER/OPERATOR MONITORING <br />15 16 <br />45 <br />17 18 <br />19 20 <br />46 <br />21 22 <br />PIPING <br />23 24 <br />49 <br />25 26 <br />50 <br />27 28 <br />UNAUTHORIZED RELEASE <br />29 30 <br />31 32 <br />52 <br />33 34 <br />_ <br />3536 <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 _ <br />FLAMMABLE VAPORS REMOVED <br />40 <br />- -- --- _ <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 ----------- <br />_--_-_---PIPING <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />- - - - <br />UNAUTHORIZED RELEASE <br />52 <br />SAMPLING <br />&53 <br />54IMPROPER <br />ABANDONMENT <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />42- <br />57 58 <br />59` <br />MAJOR MINOR <br />NO <br />❑ <br />VIOL. VIOL. <br />VIOL. <br />OFFICE: <br />INS P/' <br />RECEIVEDBY: <br />HUT -3 <br />TITLE: <br />ORIGINAL <br />PHONE: <br />5/88 ON <br />