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UNDERGROIr-n TANK PROGRAM OFFICIAL INSP�"TION REPORT <br /> S.) ZAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO, 468-3423 E <br /> SITE NAME: s s INSPECTION.DATE: lolz� <br /> SITE ADDRESS: 3 p� ����s 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 <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> EXP.DATE" EXP."DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK -- -� <br /> ,, <br /> MAJOR I MINOR <br /> PERMIT TO OPERATE 1 12 <br /> CHANGE IN CONDITIONS TO OPERATE 3 14 <br /> APPROVED CONSTRUCTION 5 16 <br /> WRITTEN MONITORING PROCEDURES 7 8 _ <br /> APPROVED MONITORING SYSTEM 9 10 J- <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 25 126 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 128 <br /> SAMPLING 29 130 I <br /> APPROVED TANK REPAIRS 31 132 _ <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD 35 �36 _ <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE - <br /> b 1 ajppT,yF ra - y$ �� yq[� ,y -s^�s; '4S' <br /> _ � y.`yA , .", fy..g <br /> REMOVAL OF RESIDUAL 38 139 <br /> FLAMMABLE VAPORS REMOVED 40 _ <br /> ACCESS LOCATIONS SEALED 41 142 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR M 44 145 <br /> P ANENT TANK CL i <br /> �.. . n .» . . � _.Y <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 17-754 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: ho - - <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. ❑ VIOL. LiVIOL. <br /> OFFICE: INSP: (� x (RECEIVED BY: <br /> TITLE: IPHONE: RECK: <br /> HUT-3 ORIGINAL <br />