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UNDERGROUt TANK PROGRAM OFFICIAL INSP "ION REPORT <br /> ,AN JOAQUIN HEALTH DISTRICT 1 or <br /> 1601 E. HAZELTON AVE. / <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: C t/X-e-h <br /> �t 2 ro,eo.✓ %yZ7� —L�,✓�=o%(. l�.Lc��.� Gvg;S?INSPECTION DATE:/, 6 <br /> SITE ADDRESS: 02O — /-1// B � / Z�`__Y/STATE/ZIP_ ('/ <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK !(/�'` TANK v TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTE <br /> TYPE OF INSPECTION SITE COMPUTER # NUMBER NUMBER NUMBER NUMBER <br /> ��✓�/ /Z�S.�.� j �j� PER# PER # PER# PER # <br /> (/ EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR I 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 9 110 <br /> MONITORING SYSTEM 11 112 <br /> APPROVED MONITOR FREQUENCY 13 114 <br /> MONITORING RECORDS MAINTAINED 15 116 <br /> ACCESS CASING SECURED 17 118 <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 J29 30 <br /> APPROVED TANK REPAIRS 32 <br /> UNAUTHORIZED RELEASES REPORTED 34 <br /> SAFETY HAZARD 36 <br /> CONDITIONS ABATED 37 <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 <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 /> _i <br /> THE MARKED.ITEMS <br /> � RF_SENT V TIONS A UST CSF f�RE �7AS1 <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:. 'Xld L /v% S <br /> -— --— —_ - <br /> 57 58 59 G� ------ L�U`�� c <br /> MAJOR MINOR NO � <br /> VIOL. El VIOL. ❑ VIOL.�. <br /> OFFICE: INSP: / LA_s✓'�r��„ RECEIVED BY: <br /> I TITLE: H IU.NL — r <br /> _ rCK -__ - - - <br /> NUT-3 <br />