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UNDERGROUND TANK PROGRAM OFFICIAL INSPF'^TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICI <br /> 1601 E. HAZELTON AVE. " <br /> COUNTY NAMEJ STOCKTON, CA 95205 COUNTY # <br /> �G)N O JN PHONE NO. 468-3423 <br /> SITE NAME: L,v INSPECTION DATE: <br /> SITE ADDRESS: o CITY/STATE/ZIP G� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# PER# PER# <br /> AAe- I I /al EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CON NTS <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 /> 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 _ <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 444r <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> 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 /> SAMPUNG 53 54 - <br /> IMPROPER ABANDONMENT 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: S2'G 58 59 <br /> 1G5 <br /> MAJOR 57 MINOR NO <br /> VIOL, 117 VIOL. VIOL. <br /> OFFICE: INSP.. L RECEIVED BY: <br /> 2� - yrsr-3/yo <br /> TITLE: 7[S PHONE: RECK: <br /> HUT-3 ORIGINAL 51W OM <br />