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t rt UNDERGROUV''NTANK PROGRAM OFFICIAL iNSPr-7:—TION REPORT <br /> k ,,;AN JOAQUIN HEALTH DISTRICT' <br /> 1601 E. HAZELTON AVE. <br /> COUNTY HAMS � pQ STOCKTON, CA 95205 COUNTY # <br /> l.6 n PHONE NO. 468-3423 <br /> SITE NAME: _I_QY a i, INSPECTION DATE: ZI Z��� <br /> U'7 f <br /> SITE ADDRESS: CITY/STATE%ZIP <br /> L4 g50 Lo 8 Yc�vk 5 i d e_ Q j II �`�`�c-}�r')(' 9 S�Ug <br /> CHANGES SITE/OWNER/PERMIT? YESO TANK TANK ,1 h TANK TANK <br /> FORM A AND/OR B SUBMITTED?r1C) COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER 6 NUMBER NUMBER <br /> ff J� PER# PER# h+ PER# PER# <br /> r-pq ol Q. I� EXP.DATE EXP.DATE it EXP.DATE EXP.DATE <br /> TANK CODITENTS :�;, +;'` _r' �; . 1 w . ra s r my .� <br /> OPERATIONAL TANK <Y,a ,<; � � , � , r s <br /> MAJOR MINORLIMB <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 -- 6 <br /> APPROVED CONSTRUCTION 5 6 - - - — <br /> WRITTEN MONITORING PROCEDURES 7 8 - -_- - _ 11 -- <br /> APPROVED MONITORING SYSTEM 9 14 0 ;h <br /> MONITORING SYSTEM 11 12 :1 <br /> APPROVED <br /> jF <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 — I� <br /> INVENTORY RECONCILIATION 21 22 ;b <br /> TANK GAUGING 23 24 __ rt I <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 -- — <br /> SAMPLING 29 30 _ —�Y--•--- —I� ;�. <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 ----- <br /> CONDITIONS ABATED 37 <br /> �1 �M ' <br /> TEMPORARY TANK CLOSURE c <br /> REMOVAL OF RESIDUAL 38 39 } !� <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING 44 45 <br /> ,1 I� <br /> It <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 � . <br /> PIPING 48 49 !! !M <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 i� I <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> S <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: no1 a ! G/-rno- p Q J ed• <br /> MAJOR 57 MINOR 58 NO 5961.1 ex <br /> VIOL- ❑ VIOL. ❑ VIOL. :• <br /> OFFICE: INSP: RECEIVED BY: '� k <br /> C �� M <br /> TITLE: PHONE: ,_ 7CK: <br /> n�lr;lnl.a.r_. area OM <br />