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UNDERGRO' TANK PROGRAM OFFICIAL INS ' 'TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIG <br /> d 1601 E. HAZELTON AVE- <br /> COUNTY NAME � w Jt7c .� STOCKTON, CA <br /> PHONE NO. 468-3423 COUNTY # 39 <br /> SITE NAME: INSPECTION DATE: U <br /> � <br /> SITE ADDRESS: OS S �� o1U o L CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK aK�GN r.4 9SZOG <br /> TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTE ll <br /> TYPE OF INSPECTION SITE COMP TER # NUMBER NUMBER NUMBER S�47 NUMBER D rl'd� <br /> PER # PER # PER # v PER # 7 9 / <br /> EXP. DATE - EXP. DATE EXP. DATE (/ P EXP. DATE�6'/ <br /> OPERATIONAL TANK <br /> TANK coNn¢rvTs ' <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 a <br /> APPROVED MONITORING SYSTEM 9 10 i <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 E <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 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 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING _ -`— --- _ <br /> 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 - - — <br /> UNAUTHORIZED RELEASE51 52 - -"""-- •- -- -- <br /> - - � -- - - - <br /> SAMPLING. <br /> 53 54 <br /> IMPROPER ABANDONMENT 55 56 -" --" -THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS (MUST MARK ONE) <br /> O� FOLLOWS: <br /> CWr9rc /Q(°-1�JOt/�t J efje `/ <br /> MAJOR 57 MINOR 58 NO �9 <br /> VIOL VIOL. El VIOL. ❑ <br /> OFFICE: INS//'IP: // //'' RECEIVED BY: <br /> L G1ll 199 oil <br /> TITLE: 57olooll PHONE: <br /> RECK: <br /> HUT-3 ORIGINAL alae <br />