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UNDERGROUP TANK PROGRAM OFFICIAL INSP TION REPORT <br /> WSAN JOAQUIN HEALTH DISTRICIW <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 <br /> COUNTY NAME C5, a, PHONE NO. 468-3423 COUNTY # 3 9 <br /> SITE NAME: A , INSPECTION DATE: �v`�a/ <br /> SITE ADDRESS: qv CITY/STATE/ZIP fin C4 9��� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK 7V-/ TANK TANK TANK <br /> FORMA AND/OR B SUBMITTED? w COMPUTER <br /> lXB� COMPUTER COMPUTER COMPUTER <br /> M <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER <br /> /! Gs PER# PER# PER # PER # <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS // /Q o <br /> MAJOR MINOR ( L�UC dew---e C� <br /> PERMIT TO OPERATE 1 2 <br /> __._.._. _.._ ._ ._._.. <br /> CHANGE IN CONDTIONS TO OPERATE 3 4 _ -- ___ <br /> APPROVED CONSTRUCTION 5 6 _ <br /> WRITTEN MONITORING PROCEDURES 7 8 " <br /> APPROVED MONITORING SYSTEM g 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 R4445 <br /> 9 _-- <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 2 <br /> ----_.... <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING qg qg <br /> FLAMMABLE VAPORS REMOVED 50 <br /> U RELEASE 51 52 <br /> SAMPLING 53 54 <br /> ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: X <br /> 57 MAJOR MINOR E]NO <br /> VIOL. VIOL. VIOL. 59 <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: � y` 5 PHONE: PECK: <br /> FB-3YG <br /> HUT-3 ORIGINAL 5ise <br />