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UNDERGROUND T`NK PROGRAM OFFICIAL INSPECT'^N REPORT <br /> S,.,, JOAQUIN HEALTH DISTRICT wor <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 9 <br /> PHONE NO. 468-3423 <br /> SITE NAME: S/ G v� 6,fc w .7-/VG INSPECTION DATE: /79 <br /> SITE ADDRESS: 36 CITY/STATE/ZIP �G4 S�z <br /> CHANGES SITE/OWNER/'PERMIT? YES NO TANK / TANK Z TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER 0 COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER 'y da NUMBER NUMBER NUMBER <br /> m <br /> �7 PER# }jjQaG PER# �, V PER # PER# <br /> '44-6;0 ( EXP.DATE- EXP.DATE s EXP_DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS ' <br /> MAJOR I MINOR <br /> PERMIT TO OPERATE 1 2 X <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 x x <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 x <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 HAZARD 35 36 <br /> CONDITIONS ABATED 711777 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED 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 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWSMAJOR ' <br /> 3 00 <br /> 57 58 Imu 59 64 �• ---� <br /> VIOL. L�& VIOLO.R ❑ VIOL❑ <br /> OFFICE: ` e�, 7 T O INSP:�d REC <br /> 7 <br /> L AP:2 if <br /> TT T TITLE: /t PHONE: RECK <br /> log - 98z -11161 <br /> HUT-3 ORIGINAL e:es <br />