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UNDERGROUK TANK PROGRAM OFFICIAL INSPF- 90N REPORT <br />SAN JOAQUIN HEALTH DISTRICT ./ <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 <br />HUT -3 ORIGINAL 5/m ©, <br />PHONE N0. 468-3423 <br />couNTY # 3 <br />SITE NAME: <br />�lA/EGjPtII/ <br />L 7 /� Vvd <br />A//I✓F7/�1� opj)�INSPECTIONDATE: <br />Z k <br />SITE ADDRESS: / / /�Au � CITY/STATE/ZIP <br />^j e4L- <br />CHANGES SITE/OWNER/ ERMIT? <br />FORM A AND/OR B SUBMITTED? <br />YES <br />NO TANK ` TANK oZ <br />TANK TANK <br />TYPE OF INSPECTION SITE COMPUTER # <br />COMPU R COMPUTER <br />NUMBER NUMBER <br />COMPUTER COMPUTER <br />NUMBER NUMBER <br />23YS PER # PER # <br />PER # PER # <br />OPERATIONAL TANK <br />EXP. DATE EXP.DATE <br />TANK CON NTS <br />EXP. DATE EXP. DATE <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 - <br />-- <br />MONITORING SYSTEM <br />11 <br />12 �"--`---- <br />_ <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />- <br />PIPING <br />19 <br />20 -_-- <br />INVENTORY RECONCILIATION <br />21 <br />22 ---- <br />-, <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 m <br />- <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />- <br />SAMPLING--`" <br />29 <br />- <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />- <br />UTHORIZED RELEASES REPORTED <br />33 <br />34 -- <br />SAFETY HAZARD <br />35 <br />---- - -- <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <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 />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />E5'47 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS <br />AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />T <br />FOLLOWS: <br />MAJOR 57 MINOR 58 NO <br />❑ ❑ <br />59 <br />Z-. Ili <br />VIOL. VIOL VIOL-rk <br />OFFICE: <br />INSP: <br />�� <br />RECEIVED BY: <br />TITLE: <br />PHONE: <br />BECK: <br />HUT -3 ORIGINAL 5/m ©, <br />