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.���•. . . UNDERGRC`'.. .n TANK PROGRAM OFFICIAL INS ''r'T10N REPORT <br /> . .�. 'AN JOAQUIN HEALTH OISTRIC <br /> 1601 E, HAZELTON AVE. <br /> COUNTY NAME STOCKTON,.CA 95205. COUNTY <br /> PHONE NO. 468-3423 <br /> SITE NAME INSPECTION TE: <br /> SITE ADDRESS: /3DS� /sow Gam' CITY/STATE/Zip <br /> CHANGES SITE/OWNER/PERMrF? YES NO TANK TANK TANK TANK F <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION5[TE COMPUTER NUMBER NUMBER NUMBER NUMBER <br /> n PER PER PER # PER# <br /> �(/r�IE Ylir�J✓�-C ��S`(� EXP.DATE EXP-DATE EXP,DATE EXR DATE <br /> OPERATIONAL TANK IA++K cor,TEr1Ts <br /> MAJOR MINOR .',t«f "�3� - :. �t �..:x-+^;. ..+wt?.' c-«X-'. r '.-w j iI <br /> PERMIT TO OPERATE 1 72 <br /> CHANGE iN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 .g <br /> WRITTEN MONITORING PROCEDURES 7 <br /> i <br /> APPROVED MONITORING SYSTEM 9 <br /> MONITORING SYSTEM 11 12 } dx^ <br /> APPROVED MONITOR FREQUENCY 13 14 ,. x. •` <br /> MONFFORING RECORDS MAINTAINED 15 18 ti,n <br /> ACCESS CASING SECURED 17 '18 G.y <br /> PIPING 19 20 C� I <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 ABATED 377M <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 M 144 145 1 �. <br /> All <br /> P ANENT TANK CL � �"�� � � '. ��` w _ x � a�►. .3� <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 i <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 p f <br /> IMPROPER ABANDONMENT 55 56 # t <br /> i THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> u SYSTEM STATUS(MUST MARK ONE) FOLL � nv" : ':� ;• - , *"�v�,.�T� <br /> I <br /> MAJOR 57 MINOR 58 NO 59 l� <br /> VIOL ❑ VIOL ❑ VIOLol <br /> OFFICE: INSP:s RECEIVED BY: <br /> ' r <br /> k <br /> TITLE: �Gff—S PHONE:., BECK; s <br />