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UNDERGROUN[)SANK PROGRAM.OFFICIAL INSPEr"ION REPO[ r <br /> AN JOAQUIN'HEALTH DISTRICT ' , <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME f STOCKTON, CA 95205 . COUNTY # 3 <br /> PHONE NO. 468-3423 I' <br /> SITE NAME: t iC.(1"1� <br /> ' `INSPECTION DATE: 6 <br /> SITE ADDRESS: CIT Y/ TAT ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK Z TANK TqN QQ� <br /> FORM A AND/OR B SUBMITTED? - COMPUTER COMPUTER COMPMER COM LITER /J <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER CSO U NUMBE �/W` NUMBER NUMBER [[JJ <br /> PER # v <br /> PER# PER # PER�# O <br /> GL �� EXP.DATI= EXP.DATE V' <br /> rExP.DEXP.DATE GOVTOPERATIONAL TANK <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORIG PROCEDURES <br /> ,. <br /> APPROVED l. 431(� YC7CN1 <br /> d MONITORING SYSTEM � 10 •.--...m.-„..._-, _ _ . _. ---- _. „-.,-.^-._...__.-_. 1E'' <br /> : <br /> -- _ _.. <br /> _ <br /> 12 <br /> E[?MONITOR FREQUENCY 13 14 A _-9l <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> -- �..� —— — �' `— <br /> ACCESS CASING SECURED. 17 <br /> 19 — <br /> zo <br /> INVENTORY RECONCILIATION 21 22 <br /> ;. <br /> w. <br /> TANK GAUGING —... . —__.._.._._ u._...__.. _.. — ..__ <br /> 23 24 4 <br /> APPROVED RESPONSE PLAN <br /> 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> I' <br /> +' <br /> ;SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 - <br /> UNAUTHORIZED RELEASES REPORTED33 <br /> 34 ” <br /> :SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> x <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" r <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 I <br /> PIPING48 ' <br /> 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE <br /> 51 52 <br /> —. .n <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 — —= .a..._. ..�.__:.. _ — _, __ ,.,_.T,. ��._.._._ ._� �__.w•:_.., _. R_.__. <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) <br /> FOLLOWS: Or ; <br /> -�'- <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. ❑ VIOL. "❑ VIOL L <br /> OFFICE: INSP: <br /> " w � RECEIVED BY: <br /> i TITLE: PHONE a BECK: ?; <br /> f <br /> HUT-3 ORIGINAL ' siva OM <br />