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i <br /> UNDERGROL' TANK PROGRAM OFFICIAL INSf ''TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT- <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMESTOCKTON, CA 95205 COUNTY #� <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE C <br /> U <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE YES NO TANK TANK 5' TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUT COMPUTER COMPUT COMPUTER <br /> T PE OF INSPECTI SITE COMPUTE # NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# PER# PER# <br /> t) EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR NONOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 <br /> APPROVED MONITORING SYSTEM 9Z710 <br /> MONITORING SYSTEM 11 1 ` <br /> APPROVED MONITOR FREQUENCY 13V 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 26 M <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 128 _ — <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 /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED ff45 <br /> OWNER/OPERATOR MONITORING 44 <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 155 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR MINOR 58 NO 59 <br /> VIOL. VIOL. ❑ <br /> 57 VIOL.❑ <br /> OFFICE: INSP: �y RECEIVED BY: <br /> TITLE: IT7I �� PHONE: BECK: <br /> HUT—,qv1`� ORIGINAL Sias OM <br />