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UNDERGROUTANK PROGRAM OFFICIAL INSP�TION REPORT <br /> bjAN JOAQUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 COUNTY # <br /> COUNTY NAME PHONE NO. 468-3423 <br /> INSPECTION DATE: <br /> SITE NAME: i„ Sh `( <br /> SITE ADDRESS: 1071 <br /> CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK ER <br /> Q/ <br /> FORM A AND/OR B SUBMITTED? NUUMBER OMPUTER / NUMBERCOMP NUMBER E� NUMBER <br /> TYP F INSPECTION SITE COMPUTER# PER# PER # PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK R MINNTLN R JJ <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <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 /> - <br /> APPROVEDRESPONSEPLAN 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 u <br /> TEMPORARY TANK CLOSURE _ <br /> REMOVAL OF RESIDUAL 38045 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 ---_-- <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING 44 <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 /> SAMPLINq 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 7z"w? / //� .3-Z - 73 <br /> MAJOR 57 MINOR El VOL LJVIOL. VIOL. <br /> OFFICE: INSP: R�CEIV BY: <br /> TITLE: -19/7' <br /> PHON BECK: <br /> / S 5/88 © <br /> HUT-3 ORIGINAL <br />