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UNDERGROUNC TANK PROGRAM OFFICIAL INSPF- T10N REPORT <br /> (�✓1 >N JOAQUIN HEALTH DISTRIC ' <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: La g�PECTION DATE: <br /> SITE ADDRESS: f (� CIT /S ATE/ZIP <br /> 1-5 76 !I <br /> CHANGES SITE/OWNER/PERMIT? YC=S NO TANK f TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTEROMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> NUMBER�(![l��. NUMBER NUMBER NUMBER <br /> �h PER# PER# PER# PER# ; <br /> IA EXP.DAT EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS Kik ' < <br /> MAJOR MINOR n£_ n <br /> PERMIT TO OPERATE 1 2 :E <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 _ <br /> APPROVED CONSTRUCTION 5 6 f <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 _is <br /> MONITORING SYSTEM 11 12 _ <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 tI <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 135 136 <br /> CONDITIONS ABATED rI <br /> 37 II i <br /> 'I <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> _ 'I <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED ! <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE rxi > , ,,`5 <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 ;i _ <br /> wile <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 I-� <br /> UNAUTHORIZED RELEASE 51 52 —I 1P <br /> SAMPLING - 53 54 —. <br /> ._. __.— <br /> IMPROPER ABANDONMENT 55 56 T� I <br /> THE MARKED TEMS REPRESENT VIOLATIONS AND MUST BE CCORR_R�EC7TED S <br /> SYSTEM STATUS(MUST MARK ONE) FOLLO SL.�b • 'r' <br /> i <br /> Z` 74D ! f <br /> MAJOR 67 MINOR 58 NO 59 S SG. /,pR I <br /> VIOL ❑ VIOL ❑ VIOL <br /> e- a B.t:. OR <br /> OFFICE: INSP ECEIVED BY: <br /> 36 TITLE:Sle—r l PH NE: ! ECK: I <br /> 60 % i <br /> HUT-3 ORIGINAL II Sias O <br /> �� I <br />