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{ UNDERGROUftLTANK PROGRAM OFFICIAL INSP TION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> _ 1601 E. HAZELTON AVE. <br /> -- STOCKTON, CA.95205 COUNTY # .. . <br /> COUNTY NAME PHONE NO. 468-3423 <br /> SITENAME: s INSPECTION DATE: <br /> • Co_ v iia <br /> SITE ADDRESS: ylo �_ �1,� CITY/STATE/ZIPS^( �_ <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER _ COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER. <br /> TYPE OF INSPECTION SITE COMPUTER# - PER# _ PER# - PER,y PER# _ <br /> EXP.DATE- EXP.DATE EXP.OATS EXP.DATE' " <br /> OPERATIONAL TANK TnN CONT N <br /> MAJOR MINOR <br /> PERMIT TO OPERATE t 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 - 36 139 1 - " - <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED - 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING - 44 - 45 - <br /> j <br /> E46 47- 48' 49MABLE VAPORS REMOVED 50 - - - - <br /> UNAUTHORIZED RELEASE 51 52 - - <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) _ FOLLOWS: <br /> 58 59 <br /> ODOR El ElOR NO <br /> ❑ VIOL E] <br /> OFFICE: INSP�R/e, Q171 RECEIVED BY: <br /> o, <br /> TITLE: AF. x/_ s PHONE: RECK r . <br /> r � <br /> ;F <br />