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UNDERGROUN ,.`TANK PROGRAM OFFICIAL <br /> ;AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. couwy # 3 j <br /> .STOCKTON, CA 95205 <br /> COUNTY NAME PHONE NO. 468-3423 <br /> INSPECTION DATE: 3�Zy <br /> ' SITE NAME: <br /> LI=t l� 7 CITY/STATE/ZIP SV 0,(,/j <br /> SITE ADDRESS: r] '7 S TANK <br /> TANK TANK <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK COMPUTER COMPUTER COMPUTER <br /> COMPUTER NUMBER NUMBER NUMBER <br /> FORM A AND/OR B SUBMITTED? NUMBER- PER# ` <br /> TYPE OF WSPECTION SITE COMPUTER# PER# PER# PER# <br /> -7/ EXP DATEEXP.DATE EXP.DATE EXP.DATE <br /> 7MK CONTENTS <br /> OPERATIONAL TANK MA OR INOR ? : <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 <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 I <br /> I <br /> CONDITIONS ABATED 37 I <br /> s <br /> TEMPORARY TANK CLOSURE , <br /> 4 REMOVAL OF RESIDUAL 38 39 <br /> t; FLAMMABLE VAPORS REMOVED t <br /> ACCESS LOCATIONS SEALED 41 42 <br /> 43 <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING 45 <br /> E <br /> PERMANENT TANK CLOSURE 00- <br /> F <br /> REMOVAL OF RESIDUAL MATERIALS 47 <br /> PIPING 48 49 -- <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING54 t <br /> IMPROPER ABANDONMENT %�—< 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS{MUST MARK ONE) FOLLOWS: Sg re, <br /> MAJOR 7 MINOR NO 59 <br /> VIOL. VIOL. ❑ VIOL❑ <br /> OFFICE: INSP:G� REC>=f D BY: <br /> t - <br /> TITLE: PHONE: ECK: <br />}, <br /> A9, <br /> sae O <br />', HUT-3 ORIGINAL <br />