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UNDERGROUF"N TANK PROGRAM OFFICIAL INSPr TION REPORT <br /> - - USAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. _ <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # ` 3 <br /> PHONE NO. 468-3423 <br /> SITE NAME: 1 { 1/ 12 p S INSPECTION DATE: L- Zy <br /> SITE ADDRESS: //v 7C� 1 m�j' CITY/STATE/ZIP G r o <br /> CHANGES SITE/OWNIERC/PERMIT? ES NO TANK TANK Z TANK 3 TANK <br /> FORM A AND/OR B SUBMITTED? Y COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTIONSITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# S3z- I PER# 1 S N 2-Z PER# /S',}?---3 PER# <br /> O L/ EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK LINK CONTENTS <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 13X 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 /> APPROVED RESPONSE PLAN 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 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 142 <br /> POWER DISCONNECTED43 <br /> OWNER/OPERATOR MONITORING 99 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 VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 2 <br /> 58 <br /> MAJOR 5 MINOR NO 59 <br /> VIOL VIOL ❑ VIOL El <br /> OFFICE: INSP: <br /> FEIVED BY: <br /> TITLE: l� S PH BECK: <br /> HUT-3 /l ORIGINAL. 5/W OM <br />