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UNDERGROU�TANK PROGRAM OFFICIAL INSP TION REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 <br />PHONE NO 468-3423 COUNTY # <br />SITE NAME: <br />SITE ADDRESS: <br />CUA <br />SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />11 <br />COMPUTER <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />19 <br />NUMBER <br />INVENTORY RECONCILIATION <br />COMPUTER <br />21 <br />22 <br />PER # <br />PER # <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />25 <br />26 <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 />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />4 <br />FLAMMABLE VAPORS REMOVED <br />MONITORING RECORDS MAINTAINED <br />INSPECTION DATE: <br />15 <br />16 <br />ACCESS CASING SECURED <br />11 <br />18 <br />PIPING <br />TANK <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />COMPUTER <br />21 <br />22 <br />TANK GAUGING <br />PER # <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />FLAMMABLE VAPORS REMOVED <br />qp <br />ACCESS LOCATIONS SEALED <br />41 <br />t45 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />44 <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 />5 <br />SAMPLING <br />53 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />ONE) <br />59 <br />MAJOR Cj MINOR o NO <br />VIOL. LJ VIOL VIOL El <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />_.,.. _..._ 4.. / - - i _ -7 <br />// _ / OZ RE Y:IJ <br />C/6F-j Yc/O <br />TITLE: P E: RECK: <br />1UT-3 ORIGINAL alae ©' <br />INSPECTION DATE: <br />CITY/STATE/ZIP <br />TANK <br />TANK <br />TANK <br />COMPUTER <br />NUMBER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />NUMBER <br />PER # <br />PER # <br />PER # <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />_.,.. _..._ 4.. / - - i _ -7 <br />// _ / OZ RE Y:IJ <br />C/6F-j Yc/O <br />TITLE: P E: RECK: <br />1UT-3 ORIGINAL alae ©' <br />