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UNDERGROL' TANK PROGRAM OFFICIAL INSP-'TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC'. n <br /> J 1601 E. HAZELTON AVE. ` <br /> � <br /> COUNTY NAME n STOCKTON, CA 95205 COUNTY # <br /> V� �� PHONE NO. 468-3423 <br /> SITE NAME: 3 <br /> INSPECTION DATE: <br /> CITY/STATE/ZIP <br /> SITE ADDRESS: � /�/�j�G j �,� <br /> CHANGES SITE/OWNER/PERMIT? YES O TANK TANK f� TANK '�/ TANK <br /> Ca COMPUTER COMPUTER OIC COMPUTER / COMPUTER <br /> FORM AAND/OR B SUBMITTED. � O � � <br /> NUMBER PER <br /> NUMBER4-.r � NUMBER NUMBER <br /> TYP F INSPECTION SI E COMPUTER# PER# . PER# PER B SUG PER # / <br /> C/f ill / y ICJ EXP.DATE tx EXP.DATE ���KS EXP.DATE <br /> 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 /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM r13 <br /> 12 <br /> APPROVED MONITOR FREQUENCY 14 <br /> MONITORING RECORDS MAINTAINED 16 <br /> ACCESS CASING SECURED 18PIPING 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 36 <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 3. <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 _ <br /> IMPROPER ABANDONMENT 155 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL. ❑ VIOL. VIOL.❑ <br /> OFFICE: INSP: RECEIVED Y: <br /> Km yow Crc�:lffl4rA �C '� <br /> TITLE: - ,1,/� PHONE: ECK: <br /> �I J <br /> HUT-3 ORIGINAL 5/88 <br />