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UNDERGROU TANK PROGRAM OFFICIAL INSP ION REPORT <br /> WSAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY #,T7 <br /> PHONE NO. 468-3423 <br /> SITE NAME: 5 � INSPECTION DATE: 2-1t p/-Pf <br /> SITE ADDRESS: /34/ S, CITY/STATE/ZIP o� � <br /> CHANGES SITE/OWNER/PERMIT? YES N TANK p TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> 23 3cl EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL K TANK 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 13 14 <br /> -- <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> �._ <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 124 <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 39 777 -44 45FLAMMABLE VAPORS REMOVED 40ACCESS LOCATIONS SEALED 41 42POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE z. <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 E CORR1ECTED/AS <br /> SYSTEM STATUS(MUST MARK ONE) FO S d Gi <br /> 58 <br /> MAJOR 57 MINOR NO 59 <br /> VIOL. 1Y VIOL. ❑ VIOL❑ <br /> e <br /> 9 Ct roc <br /> OFFICE: INSPi . RECEIVED BY: <br /> TITLE:,Q,6#3 PHONE: BECK: <br /> HUT-3 ORIGINAL Sieg ©, <br />