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UNDERGROU TANK PROGRAM OFFICIAL INSF _ :TION REPORT <br />I EXP. DATE <br />EXP. DATE EXP. DATE EXP. DATi <br />SAN JOAQUIN HEALTH DISTRICT <br />TANK CONTENTS <br />COUNTY NAME '� <br />So <br />1601 E. HAZELTON AVE. <br />STOCKTON,CA 95205 <br />COUNTY # <br />G� <br />3 / <br />L <br />PHONE NO. 468-3423 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />SITE NAME: I d Q � <br />- <br />APPROVED CONSTRUCTION <br />INSPECTION <br />DATE: <br />SITE ADDRESS: <br />F'5 -F. <br />CITY/STATE/ZIPC <br />��a <br />-44wil��4' <br />CHANGES SITE/OWNER/PERMIT? <br />YES NO TANK 61 TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER COMPUTER <br />COMPUTER <br />COMPUTER <br />MONITORING RECORDS MAINTAINED <br />NUMBER NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE COMPUTER # PER # PER # <br />PER # <br />PER # <br />�`q/vLK uiC <br />I EXP. DATE <br />EXP. DATE EXP. DATE EXP. DATi <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />T <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 p� <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED 33 34 <br />_ <br />SAFETY HAZARD <br />35 136 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40ME <br />_ <br />ACCESS LOCATIONS SEALED <br />41 42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />_ <br />UNAUTHORIZED RELEASE <br />2 <br />51154 <br />SAMPLING <br />53 <br />_ <br />IMPROPER ABANDONMENT <br />55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />40 42 <br />57 58 <br />59 <br />MAJOR <br />❑ VIOLL.. R ❑ <br />VOL. ❑ <br />VIOL. <br />OFFICE: <br />INSP: <br />RECEIVED BY: <br />TITLEw"r <br />PHONE: <br />BECK: <br />--IUT-3 <br />