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UNDERGROUf''llk TANK PROGRAM OFFICIAL INSPP'"ON REPORT <br /> SAN JOAQUIN HEALTH DISTRIC't,_,/ <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME //�7 d STOCKTNO. 46 95205 COUNTY # 3 q <br /> C.'v`n LJ'--C PHONE NO. 468-3423 1 <br /> SITE NAME: �!)tbc Ltc INSPECTION DATE: <br /> SITE ADDRESS: ��� lJpi; l!},,,�y CITY/STATE/ZIP 4 4 <br /> CHANGES SITE/OWNER/PERMIT? YES (� TANK 0 / TANK CC TANK 03 TCI- A�erm ANK <br /> FORM <br /> FORM A AND/OR B SUBMITTED?*5-bdb _ COMPUTER COMPUTER COMPUTER COMPUTER <br /> TyfE OF INSPE TION SITE COMPUTER !► NUMBER !DK NUMBER 1pl[ NUMBER ,,L,_ NUMBER <br /> ON <br /> y �� PER# U,1,, PER * f� p Q PER # PER# <br /> b 1j ! EXP.DATE EXP.DATEf' EXP.DATE EXP.DAT <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 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <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 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 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 <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 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONES <br /> FOLLOWS:-.�P-�-- - - <br /> MAJOR 57 58 MINOR NO S9 �J ' <br /> VIOL LiVIOL LiVIOL (� <br /> OFFICE: INSP: FYI lb RECEIVE[go / <br /> � o �7 <br /> y <br /> TITLE: .0 PHONE: � � <br /> .E cJ <br /> HUT-3 ORIGINAL <br />