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III 1 _ -�'�1-- •- -- _ <br /> UNDERGROWP4*fANK PROGRAM OFFICIAL INSPF,qlON REPORT <br /> ,SAN JOAQUIN HEALTH DISTRICTs <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205, <br /> COUNTY NAME ' AIJ.-i(),4n PHONE,NO, COUNTY #'3 <br /> .5 <br /> SITE NAME: ; — '- Y` = INSPECTION DATE:.--', <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT?.-_-YES., NO TANK b -� ,. TANK TANK _ TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTER - COMPUTER ,. COMPUTERt .. <br /> NUMBER , -- NUMBER NUMBER NUMBER , <br /> _ TYPE OF INSPECTION SITE COMPUTER# r <br /> PER 'PER# _ _ PER# _ -~'=r. - PER.0 y <br /> 1 EXP.DATE EXP.DATE EXP.DATE EXP,DATE�� <br /> OPERATIONAL.TANK 61 <br /> 'TANK conrrErns ' k { <br /> .., MAJOR MINOR 4 .c ,a _ '+fir <br />-� PERMIT TO OPERATE 1 2 _ <br /> CHANGE IN CONDI'T'IONS 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 FR60UEN6Y — .13 14 K`' r` _ • <br /> MONITORING RECORDS MAINTAINED r 1 15 lie <br /> ACCESS CASING SECURED r ;x. .17 18 "r> -., '� <br /> PIPING 19 20 <br /> ....� a„ . <br /> INVENTORY RECON_CILIATION 21 22 <br /> TANK GAUGING - 23 24' <br /> APPROVED RESPONSE PLAN _ _ 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 . 28 t <br /> SAMPLINGI a t 29- 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED- 33 34 ; <br /> .SAFETY HAZARD i 35 36,.. <br /> CONDITIONS ABATED �^ 37• w•F - " _ I <br /> TEMPORARY TANK CLOSURE ,"�`` M ` h '�" q ,,, ;; °" �"~ � ►ya► ,, <br /> REMOVAL OF RESIDUAL' f; 3E3"• 39 r" -• i <br /> FLAMMABLE VAPORS REMOVED 40 'x <br /> ACCESS LOCATIONS SEALED 41- 42' k 7 <br /> POWER DISCONNECTED 43. <br /> OWNER/OPERATOR MONITORING - 44 45 <br /> LA <br /> 44. <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46' 47 <br /> PIPING >i. � :=�.. _P" 48 s :. ',•;: _ <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE :' 51 - 52 •g: " ; I <br /> a <br /> SAMPLING F53 ': 54 <br /> IMPROPER ABANDONMENT <br /> of• -� _"` THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS . <br /> SYSTEM STATUS(MUST MARK ONE) ; % r ,FOLLOWS: <br /> MAJOR" 57 a. • ;'MINOR NO58 <br /> -5`9�� <br /> VIOL. VIOL-' ❑ - "VIOL <br /> OFFICE: INSP: r , '' r RECEIVED BY: <br /> TlTLE: I j,- 1 A N 4 PHONE: I.RECK: <br /> OM <br /> ;HUT-3 i. ORIGINAL .Y, s�ee': <br />