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UNDERGROUN— TANK PROGRAM OFFICIAL INSPE -ION REPORT 77—Atj c e$ <br /> . 6AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # ` <br /> PHONE NO. 468-3423 <br /> SITE NAME: c /V� �KG INSPECTION <br /> DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE/l�,,F IN,$(.P,.ECjTION�,/f �y SITE COM/P/,UT'EJR/,,f� NUMBEF�1 NUMBER NUMBER NUMBER <br /> r(/lI Z ,7�7 1 " ( 1" EXP.DATEIWov; EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK—NT NTS <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 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 REPORTEDL35 <br /> 34 <br /> SAFETY HAZARD 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <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 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKE ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOW';' �2G��lDN �uPi <br /> MAJOR 57 MINOR 56 NO 59 L(l <br /> VIOL VIOL ❑ VIOL.❑ <br /> e <br /> A, v --q 2 <br /> OFFICE: INSP: RECEI D BY: <br /> lal� <br /> TITLE: �� PHOW RECK: <br /> 7c�3—J J J <br /> HUT-3 ORIGINAL sine OM <br />