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' J UNDERGROUNaJ�AANK PROGRAM OFFICIAL INSPEV ON REPORT <br /> WAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 <br /> COUNTY NAME PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: INSPECTION DATE: tzi cm <br /> SITE ADDRESS: cl CITY/STATE/ZIP AK <br /> TANK <br /> C9S1-� <br /> CHANGES SITE/OWNER/PERMIT? YES O TANK- 05 TANK TANK TA <br /> COMPUTER COMPUTER COMPUTER COMPUTER <br /> FORM AAND/OR B SUBMITTED? <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER # PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP DATE <br /> OPERATIONAL TANK TA[19 <br /> NK MINOR <br /> MINOR <br /> PERMIT TO OPERATE 2 <br /> CHANGE IN CONDITIONS TO OPERATE 4 ✓. _ --- <br /> APPROVED CONSTRUCTION 6 <br /> WRITTEN MONITORING PROCEDURES 8 <br /> APPROVED MONITORING SYSTEM 10 <br /> MONITORING SYSTEM 12 -- <br /> APPROVED MONITOR FREQUENCY 14 ��-- ..... <br /> MONITORING RECORDS MAINTAINED 16 <br /> ACCESS CASING SECURED 18 <br /> PIPING 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 42 <br /> POWER DISCONNECTED m 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 VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 58 59 <br /> MAJOR 57 MINOR NO - <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INSP: RECEIVED BY:..,4p4-rvgp TIJ= <br /> c�4 752zd <br /> TITLE: s , PHOZa�ti) �68-033 RECK: <br /> ( siaa <br /> HUT-3 ORIGINAL <br />