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UNDERGROUW'_TANK PROGRAM OFFICIAL INSPE )ION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> .COUNTY NAME STpCKTCA 95205 COUNTY # 3 <br /> w{�f � PHONE NO.NO. 468-3423 <br /> SITE NAME: — INSPECTION DATE: <br /> i <br /> SITE ADDRESS: 1 C{("4tu— RC4 CITY/STATE/ZIP <br /> CHANGES SITE YES I NO TANK Q 1 TANK TANK 03 TANK O y <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE <br /> nOF�INSPECTION SITE <br /> }COMPUTER# PER# iy PER# PER# PER# I <br /> r/ �y r i EXP.DATE EXP:DATE EXP.DATE EXP,DATE <br /> OPERATIONAL TANK TANK`CONTENTS � <br /> Y� , P � � " > � � •�� Wit. <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 8k <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 3 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTE© 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 i1 <br /> � 1 <br /> TEMPORARY TANK CLOSURE <br /> R �::...,erg.... .... �° : . . . .RFa.... ..�..:..:. ... ..._,. ...-_�, .....: ....�- ,_ � ..° ..__ , <br /> REMOVAL OF RESIDUAL 38 139 1 <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 ` g <br /> REMOVAL OF RESIDUAL MATERIALS ? 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE # 51 52 <br /> SAMPLING i 53 54 ' <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 59 <br /> Vfl <br /> ld ❑ VIOL. ❑ VOL.❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> } i <br /> TITLE: PHONE: BECK:LI I <br /> ; <br /> r <br /> HUT-3 FILE COPY 5/88 <br />