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UNDERGROIINI'ANK PROGRAM OFFICIAL INSPFrl�"+ON REPORT <br /> t AN JOAQUIN HEALTH DISTRIC _ <br /> 1601 E. HAZELTON AVE. `I <br /> COUNTY NAME STOCKTON, CA ss2as � COUNTY # ; <br /> PHONE NO. 468-3423 <br /> � f <br /> SITE NAME: `k !� INSPECTION DATE: <br /> t"": k <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 /> NUMBER NUMBER NUMBER NUMBER f <br /> TYPE OF INSPECTION SITE COMPUTER# 1 h <br /> TQC r1 PER#e[S?j—G'/ PER#d5 7 r ^``U Z PER# PER # <br /> ir7 0, 7 EXP.DATE' EXP.DATE II EXP.DATE EXP.DATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK >;, <br /> MAJOR_ MINOR tiy� ns- .� s <br /> PERMIT TO OPERATE 1 2 :t <br /> CHANGE IN CONDITIONS TO OPERATE 3 q <br /> APPROVED CONSTRUCTION 5 g <br /> WRITTEN MONITORING PROCEDURES 7 8 yy <br /> APPROVED MONITORING SYSTEM 9 10 h <br /> MONITORING SYSTEM 11 112 <br /> APPROVED MONITOR FREQUENCY 13 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED •17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 I <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 t <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 - � ---•--_�______��.._ ___.�—�____ <br /> TEMPORARY TANK CLOSURE *^ � � <br /> , �, <br /> 51, <br /> ' <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 I jh- <br /> PCWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 F <br /> PERMANENT TANK CLOSURE 'k T. <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50VZl NO, I <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: �� .t es �~ Imo'✓ U QTS <br /> =.s f j II c :. �, y <br /> MAJOR 57 MINOR NO 59 <br /> 58 <br /> a 1 <br /> VIOL. ❑ VIOL. ❑ VIOL. :� r `• 1 <br /> ,I 1 <br /> OFFICE: INSP: RECEIVED BY: f <br /> ., <br /> TITLE: ��ff� PHONE: BECK: <br /> HUT-3 ORIGINAL <br />