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' II <br /> r,CTION REPORT <br /> UNDERGROt> +Ap TANK PROGRAM OFFICIAL iNSP <br /> SAN JOAOUIN HEALTH DISTRIC' -1 <br /> 1601 E. HAZELTON AVE_ " <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 ;, <br /> I <br /> SITE NAME: �` INSPECTION DATE: <br /> /Yl?� <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> 3 <br /> ' TYPE Of INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# j,7:0PERiI <br /> D PER# a��I U� <br /> J ern O v ciJC - 7 EXP.DATE EXP.D TE EXP.DATE EXP,DATE <br /> TANK CONTENTS S.h <br /> OPERATIONAL TANK u � <br /> MAJOR MINOR � e. N N, 0 , <br /> PERMIT TO OPERATE 1 2- <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 � <br /> APPROVED CONSTRUCTION 5 6 s' <br /> WRITTEN MONITORING PROCEDURES 7 8 .� <br /> APPROVED MONITORING SYSTEM 9 10 II j <br /> MONITORING SYSTEM 11 12 h <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 I <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 ---- �--- I, --- — - - _ <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE ` <br /> z3�r. s'A�,—,r <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 W 1, <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 451-ul <br /> .a <br /> I� l <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> i <br /> t <br /> PIPING 48 49 - - <br /> FLAMMABLE VAPORS REMOVED 50 la <br /> { UNAUTHORIZED RELEASE 51 52 ;1 <br /> SAMPLING 53 54 1 <br /> IMPROPER ABANDONMENT 55 56 II <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED As <br /> E <br /> SYSTEM STATUS(MUST MARK ONE) FOLLPWS: &A v�.c�p a� a acs # <br /> 0146 s`C.o f T-) i] �.; .Gcv C u�c 6 v c-cep A <br /> MAJOR 57 MINOR 58 NO 59 4 w Jl -- Cle T <br /> VIOL. ❑ VIOL '❑ VIOL �. ■a —Q <br /> it <br /> OFFICE: INSP: RECEIVED BY: <br /> �i <br /> TITLE: ,cf f PHONE: BECK: } <br /> HUT-3 ORIGINAL :1 5i8B C <br />