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UNDERGROUf- TANK PROGRAM OFFICIAL INSP' 7ION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> TJ 1601 E. HAZELTON AVE, \a n- <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # `rff <br /> CJ PHONE NO. 468-3423 <br /> SITE NAME: Ca4 pJ D <br /> INSPECTION DATE: �j/ZIg <br /> SITE ADDRESS: 5 W. o/„�� CITY/STATE/ZIP //"T n q6zo <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK � TANK 3 TANK � TANK <br /> FORM A AND/OR B SUBMITTED?_\)65 COMPUTER COMPUTER /COMPUTER COMPUTER <br /> T �PEy�O,F INSPECRo <br /> SITE COMPUTER# NUMBER y _ NUMBER /�G NUMBER NUMBER <br /> i�f/IDUG(X (j / PER #�CJ (',nl'p'1G� PER # PER # PER! EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 / 1� <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 y <br /> MONITORING SYSTEM 11 12 �CLtL(�6�(�CLJC <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 18 <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 P9 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD 35 136 <br /> CONDITIONS ABATED 37 <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 /> REMO MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <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 ONLJ FOLLOWS: Q <br /> MAJOR 57 MINOR 58 NO <br /> I VIOL. E] VIOL. F-1 MINOR <br /> OFFICE: INSP: am ! /��� - RECEIVED BY: <br /> TITLE:&--/-) <br /> IIIT-3 ORIGINAL seas O <br />