Laserfiche WebLink
UNDERGROL' _­� TANK PROGRAM OFFICIAL INSF TION REPORT G <br /> SAN JOAQUIN HEALTH DISTRIC'i 0 <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMESZy1 STOCKTON, CA 95205 COUNTY #3+; <br /> PHONE NO. 468-3423 <br /> SITE NAME: S 1 ?) �l � G� INSPECTION DATE: <br /> SITE ADDRESS: ! CITY/STATE/ZIP StGA4-clevi 64 1?51:�05 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK O( TANK O 1 TANK O <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # PER # PER # PER # <br /> (/ 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 <br /> _ _ !q MoD Do <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 QQ <br /> APPROVED MONITOR FREQUENCY 13 14 Wa <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 T <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 v <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 m <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 <br /> SAMPLING 53 547 <br /> IMPROPER ABANDONMENT 55 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 MAJOR MINORV <br /> NO <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INSP: RECEIVED BY: <br /> iyn��G <br /> TITLE: { S PHONE: BECK: <br /> HUT-3 ORIGINAL W'538 C,. <br />