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UNDERGROU TANK PROGRAM OFFICIAL INS P TION REPORT <br /> SAN JOAGUIN HEALTH DISTRICI� <br /> 0 1601 E. HAZELTON AVE. <br /> COUNTY NAME �0 STOCKTON, CA 95205 COUNTY # '_39 <br /> PHONE NO. 468-3423 <br /> SITE NAME: L oco, I rc' INSPECTION DATE: �,23 j <br /> SITE ADDRESS: 2,b 60 H � Dodo CITY/STATE/ZIPn��(� (Z} 95&3 <br /> CHANGES SITE ES NO TANK TANK TANK I TANK ✓/ <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TY O�F�yIfN1�-SPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> ou( 'I I e� 119/ EXP.DATE - EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 <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 111 12 <br /> APPROVED MONITOR FREQUENCY 13 - 14\ <br /> MONITORING RECORDS MAINTAINED 15 16,E <br /> ACCESS CASING SECURED (29 <br /> 18 <br /> PIPING 20, _ <br /> INVENTORY RECONCILIATION 22 <br /> TANK GAUGING 24 <br /> APPROVED RESPONSE PLAN 26 _ <br /> UNAUTHORIZED RELEASE OCCURRENCE 28( <br /> SAMPLING 30 <br /> APPROVED TANK REPAIRS 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 136 I <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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 /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOL�ONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: ��' - <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL VIOL. VIOL. <br /> OFFICE: INSP: , nen /I�' o� �VED BY: <br /> TITLE: f /� /�{ PHONE: RECK: <br /> dUT-3 ,\ ORIGINAL 5ie5 ©M <br />