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UNDERGROU►''TANK PROGRAM OFFICIAL INSr -TION REPORT <br /> 4 `4AN JOAQUIN HEALTH DISTRIC l �'- <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 cawy # <br /> cwNw <br /> p V PHONE NO. 468-3423 j <br /> SITE NAME: �J'(Lc°i f.b G F- 6b 12,E q+ "" i INSPECTION DATE: <br /> SITE ADDRESS: nj S U A,V U, V,,, CITY/STATE/ZIP <br /> Kww—ES SITE/OWNER/PERMIT? YES NO TANK ANK TANK TANK <br /> ORM A AND/OR B SUBMITTED? C COMPUTER COMPUTER COMPUTER <br /> SITE COMPUTER# NUMBER � NUMBER NUMBER NUMBER <br /> OF INSPECTION PER#k 1 n ely� PER# PER# PER# <br /> pri-I V- d f EXP.DATE . EXP.DATE I EXP.DATE EXP.DATE <br /> E7 <br /> OPERAnONAL TANK TAM cowrOrts <br /> MAJOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE MI CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 wr __ ._.___..________. <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 /> 'DIN(GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> _.__-________._.__.., .._ _.............________..___..___ <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE; <br /> g <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 45 <br /> PERMANENT TANK CLOSURE . <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS I4EP�119ESENT VIOLATIONS AND <br /> � BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS' (T <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL. ❑ VIOL ❑ VIOL <br /> OFFICE: INSP: ECEIVED BY: <br /> TITLE: S j PHONE: RECK: <br /> r1UT--3 ORIGINAL stea 0M <br />