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UNDERGROU TANK PROGRAM OFFICIAL INSTlON REPORT <br /> SAN JOAQUIN HEALTH DISTRICT* <br /> 1601 E. HAZELTON AVE. Tw <br /> . - � L STOCKTON, CA 95205COUNTY NAME <br /> PHONE NO. 468-3423 COUNTY # I <br /> SITE NAME: E <br /> J f INSPECTION DAT : ,� f <br /> I <br /> SITE ADDRESS: JYE f_ CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK; TANK ; TANK TANK I <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE <br /> OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS : ga ;ooh I <br /> MAJOR MINOR zax <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" j <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 i <br /> INVENTORY RECONCILIATION 21 22 j <br /> TANK GAUGING 23 24.x'' <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 /> S <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 �- <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE � '� �� �v <br /> REMOVAL OF RESIDUAL MATERIALS 46 147 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 � . <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 .4 <br /> IMPROPER ABANDONMENT 55 56 - <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS i <br /> SYSTEM STATUS(MUST MARK ONE) <br /> FOLLOWS: ^�• ' •t` /_F ;`f.:' <br /> i <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. ElVIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: r RECEIVED BY: i <br /> TITLE: . ,V06?iq ytt PHONE: 7CK: <br /> Apn e '. <br /> HUT-3 FILE COPY <br />