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UNDERGROUP' TANK PROGRAM OFFICIAL INSPF"TION REPORT <br /> ..SAN JOAOUIN HEALTH DISTRICT,-,, <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME&� STOCKTON, CA 95205 Q <br /> .l PHONE NO. 468-3423 COUNTY #� <br /> SITE NAME: 3 !� Q___ „ _ INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP�(�' <br /> CHANGES SITE/OWNER/PERMIT? YES NO ANK D/ TANK X--N-- TANK p TANK1�O�q/7� <br /> FORM RAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPU ER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> r PER# PER # PER# PER# <br /> / EXP.DATE EXP.DATE EXP.DATE _EP-DATE <br /> OPERATIONAL TANK MAJOR IM NOR �5 <br /> PERMIT TO OPERATE 1 2 <br /> CIO <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM d2122 10 <br /> MONITORING SYSTEM Ti- 12 -- <br /> APPROVED MONITOR FREQUENCY 14 <br /> MONITORING RECORDS MAINTAINED 16 <br /> ACCESS CASING SECURED 18 <br /> PIPING 20 <br /> INVENTORY RECONCILIATION <br /> TANK GAUGING 23 24 - - -- <br /> _. —. <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 /> _. _.._ <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <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 /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL VIOL ❑ VIOL❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: R EPHONE: BECK: <br /> HUT-3 ORIGINAL siee 0M <br />