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UNDERGROU TANK PROGRAMOF 1CIAL INSP TION REPORT <br /> SAN JOAOUIN HEAL DISTRIC <br /> 1601 E. HAZELTON AVE. t <br /> STOCKTON, CA 9 205 <br /> COUNTY NAME tS ail PHONE NO. 468- 423 COUNTY # <br /> SITE NAME: ` V v INSPECTION DATE: <br /> SITE ADDRESS: a S, CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK C7 f TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER # PER# <br /> PiYYL�V a.� 1 D `f D EXP.DATE' EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK raHK coKrs :' <br /> MW <br /> MAJOR MINOR ` ,,X <br /> PR <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 <br /> ACCESS CASING SECURED 17 18 <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 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATEDa. <br /> TEMPORARY TANK CLOSUREO4x <br /> REMOVAL OF RESIDUAL 38 39 <br /> i FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 _ <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE . � w <br /> j REMOVAL OF RESIDUAL MATERIALS 46 47 � <br /> PIPING 48 49 <br /> I FLAMMABLE VAPORS REMOVED 50 — <br /> UNAUTHORIZED RELEASE 51 52 — <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br />! THE MARKED ITEM REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAJ` VIOLOR ❑ VIOL LiVOL.❑ <br /> i <br /> OFFICE: INSP:0 '6U a�,o <br /> REtCEIVED BY: <br /> TITLE: S PHONE: BECK: <br /> HUT-3 ORICINAL 9/88 O� <br />