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UNDERGROU."ir "TANK PROGRAM OFFICIAL INSPFr"(ON REPORT <br /> ( AN JOAOUIN HEALTH DISTRICT k d <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON• CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: Z INSPECTION DATE: <br /> SITE ADDRESS: ,d CITY/STATE/ZIP , <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER ,COMPUTER COMPUTER <br /> T NUMBER NUMBER NUMBER 'NUMBER <br /> TYPEOFINSPECTION SITE COMPUTER ,* PE7,p1_Ql PER# 15,_P.Oy PER# h/7��15 PER # <br /> TL�h P'4�H-c Li �57�- EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK raNic cowrerrs � 07 , <br /> MAJOR MINOR �;fi..r , � <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 10C"'► <br /> MONITORING SYSTEM 11 12 ' <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 �` <br /> ACCESS CASING SECURED 17 18 _ C <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 Y"" P <br /> TANK GAUGING 23 24 �p <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 35 136 <br /> CONDITIONS ABATED VZ, 37 <br /> TEMPORARY TANK CLOSURE <br /> - k*;.r 4 r,c9ssx, s xx�ss e it 4�.33.,r �:.�',;..n. &C a:�- $ +`f' ..�,•>,[) <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 i <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 144 14E.raA <br /> 5 i <br /> ERMANENT TANK CLOSURa s W t <br /> M4.r ".`-�Scvi r.:ra -x <br /> REMOVAL OF R SID AL 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 y <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTE�ws SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 14 FS <br /> 6AI A. <br /> MAJOR 57 MINOR 58 NO 59 s. <br /> VIOL. Li VIOL ❑ VIOLZ U <br /> OFFICE: INSP:/)_ f RECEIVED BY: <br /> TITLE: G , s PHONE: PECK: <br /> HUT-3 ORIGINAL <br />