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UNDERGROUWkTANK PROGRAM OFFICIAL INSP TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIClW <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # ` <br /> PHONE NO. 468-3423 <br /> SITE NAME: 61 <br /> NO N�L INSPECTION DATE z <br /> SITE ADDRESS: CITY/STATE/ZIPZS <br /> CHANGES SITE/OWNER/PERMIT? ES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED. t COMPUTER q COMPUTER COMPUTER 7 COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER Vj NUMBER NUMBER �J NUMBER <br /> EXP.DATE EXP_DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CON>EN s <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE <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 33 34 - - <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> -- <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 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 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> __.. <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED TEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: �2 �✓✓ //L1 <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. ❑ VIOL ❑ VIO <br /> OFFICE: INSP: � }, � RECEIVED BY: <br /> es�-b _ �/ �Jr <br /> TITLE:(�J PHONE: RECK: <br /> HUT-3 ORIGINAL. siaa ©M <br />