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UNDERGR+.V^ TANK PROGRAM OFFICIAL INiwwE^TION REPORT 3 1-r Ll <br /> ,;AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: gN - � INSPECTION DATE: ' �Y <br /> SITE ADDRESS: �7 J. /2,7,4 p, <br /> � Lln CITY/STATE/ZIPr' �C -5 3 /6-�C <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER f) COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER # <br /> NUMBER �� ,L NUMBER 90 NUMBER NUMBER <br /> PER# CI�tT�G PER# 6) PER# PER# <br /> 1 L EXP.DATE V EXP.DATE EXP.DATE EXP.DATE <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 CLOSUREa <br /> 1!a x <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 46 147 <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 PSS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:57 58 5 <br /> 2 <br /> MAJOR MINOR NO (.fl <br /> VIOL. VIOL. LJ VIOL.LL <br /> OFFICE: INSP: RECEIVED BY: <br /> 7 I <br /> TITLE:�� � PHONE: BECK: <br /> Wf IT-z n <br />