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UNDERGROk�- ANK PROGRAM OFFICIAL INSE'' ON REPORT <br /> • IAN JOAQUIN HEALTH DISTRIC"�_0 <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: / INSPECTION DATE: <br /> /e 9/ <br /> SITE ADDRESS: { CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR 8 SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER # /SNS-O3 <br /> _ PER # /% C / PER# /S L�-/) PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR I 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 7 .. <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 f <br /> APPROVED MONITOR FREQUENCY 13 14 ��S J/"`� _ Q•Fr.L�P __ <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 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <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 138 139 <br /> FLAMMABLE VAPORS REMOVED 140 <br /> ACCESS LOCATIONS SEALED 141 142 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE ` � <br /> ,nt ti: e '3srs�y <br /> x <br /> REMOVAL SIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: '� (' " `✓ <br /> MAJOR 57 MINOR 58 NO 5�9 <br /> VIOL ❑ VIOL. ❑ VIOL. 2117! %�f>-J�'�+�• �._=' <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: p F; f� Sr PHONE: RECK <br /> HUT-3 OWNER'S COPY 5188 0M <br />