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UNDERGROIi�-,TANK PROGRAM OFFICIAL INS' "-"PION REPORT <br /> SAN JOAOUIN HEALTH DISTRIC.- <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME OQ'/1� STOCKTON, CA 95205 COUNTY #,3 9 <br /> `�-� 19 Q PHONE NO. 468-3423 <br /> SITE NAME: .. -• INSPECTION DATE: <br /> SITE ADDRESS: <br /> 3573-5 4, CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK `� TANK $/ TANK 9 TANK l (' <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTER COMPUTE COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE�OF�INSPECTION <br /> � SITE COMPUTER# PER* PER# PER# PER# <br /> EXP.DATE' EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS k s ; <br /> MAJOR MINOR <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 W Y <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 I <br /> - 9 <br /> PIPING 19 20 ' <br /> �o Q. <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 i30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 - -- <br /> SAFETY HAZARD 35 36 — <br /> CONDITIONS ABATED <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 MONITORING 44 145 <br /> PERMANENT TANK TANK CLOSUREy ` <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 149 —� <br /> FLAMMABLE VAPORS REMOVED 50 -- <br /> UNAUTHORIZED RELEASE 51 152 ✓/" __ <br /> SAMPLING 53 54 --- - --- -- - <br /> IMPROPER ABANDONMENT 55 166 -'-- <br /> THE MARKED RESVIOLATIONS M BE CORRECTED qS� <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO <br /> �— <br /> 59 <br /> ► ooP�va�s � �— <br /> VIOL. ❑ VIOL. It V <br /> ElVIOL.❑ "r'j� , <br /> .5 <br /> TITLE: HONE: RECK: <br /> ti <br /> HUT-3 ORI INAL 5/es OO <br />