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I UNDERGROU -n TANK PROGRAM OFFICIAL INSE.F"TION REPORT <br /> k,/'SAN JOAQUIN HEALTH DJSTRICI,,,J <br /> i 1601 E. HAZELTON AVE. <br /> COUNTY NAME i STOCKTON, CA 95205 <br /> PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: ^� � <br /> INSPECTION DAT ' 8r <br /> 1 SITE ADDRESS: CITY/STATE/ZIP L� , <br /> y <br /> CHANGES SITE/OWNER/PERMIT?/�- YE$ N TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER�� COMPUTER TANK <br /> NUMBER NUMBER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER <br /> ] L//.� PER# PER# PER# PER# <br /> EXP DATE EXP DATE EXP DATE EXP DATE I <br /> OPERATIONAL TANK TANK CON S rs <br /> MAJOR MINOR +., <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS.TO OPERATE 3 q <br /> APPROVED CONSTRUCTION 5 g --'---- <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 33 134 <br /> SAFETY HAZARD <br /> CONDITIONS ABATED 37 — <br /> TEMPORARY TANK CLOSURE x r* £ x y y } < rn ? I <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 /> I <br /> PERMANENT TANK CLOSURE x � k * g <br /> ��s.'�f,' l;.'4x'4. ..,. � <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 — r <br /> SAMPLING 5354 ' <br /> IMPROPER ABANDONMENT 55 56 ^' 3 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: S Gr>wr`+�RC� <br /> MAJOR 57 MINOR 58 NO 59Irm D . <br /> VIOL. ❑ VIOL. ❑ VIOL.,❑ <br /> OFFICE: INSP:A RECEIVED BY: <br /> TITLE: /L>64'f PHONE: PECK: <br /> HUT-3 / OWNER'S COPY siea ©M <br />