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UNDERGROUt 'CNK PROGRAM OFFICIAL <br /> DISTRICT' <br /> TION REPORT <br /> ,..,.N JOA <br /> 1601 E. HAZELTON AVE. COUNTY # <br /> STOCKTON, CA 95205 <br /> COUNTY NAME <� PHONE N0. 468-3423 <br /> INSPECTION DATE: <br /> SITE NAME: S/4(� �' - <br /> ` �^/]C � CIT /STAT TANK Z ZIP <br /> ` 1'/( <br /> SITE ADDRESS: TANK TANK <br /> / COMPUTER <br /> COMPUTER <br /> CHANGES SITE/OWNER/PERMIT? YES NO COMPUTER COMPUTER NUMBER <br /> FORM A AND/OR B SUBMITTED? NUMBER NUMBER NUMBER <br /> PER# PER# <br /> TYPE OF INSPECTION PER# <br /> SITE COMPUTER# PER# EXP.DATE <br /> D <br /> e EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS O <br /> OPERATIONAL TANK MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 5 6 <br /> APPROVED CONSTRUCTION - --- --- -•---•----- - <br /> WRITTEN MONITORING PROCEDURES 9 10 <br /> 7 8 <br /> APPROVED MONITORING SYSTEM 11 12 <br /> MONITORING SYSTEM 13 14 _ <br /> APPROVED MONITOR FREQUENCY ------ <br /> 15 16 ------- <br /> MONITORING RECORDS MAINTAINED 17 18 - `- <br /> ACCESS CASING SECURED 19 20 - _ --- <br /> PIPING <br /> INVENTORY RECONCILIATION 21 2223 24 <br /> TANK GAUGING 25 26 <br /> APPROVED RESPONSE PLAN <br /> 28 <br /> UNAUTHORIZED RELEASE OCCURRENCE 29 30 _ - ----- ----- ^�~ �- _ -. <br /> SAMPLING 31 32 <br /> APPROVED TANK REPAIRS <br /> - <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> _ <br /> 35 36 <br /> SAFETY HAZARD 37 -"^- <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 --" - <br /> 40 <br /> FLAMMABLE VAPORS REMOVED 41 42 - <br /> __ <br /> ACCESS LOCATIONS SEALED <br /> 43 <br /> POWER DISCONNECTED 44 45 <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE �� r <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> - - - - <br /> 48 49 <br /> PIPING 50 <br /> FLAMMABLE VAPORS REMOVED 51 52 <br /> UNAUTHORIZED RELEASE 53 54 - <br /> SAMPLING 55 56 <br /> IMPROPER ABANDONMENT THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> V <br /> 58 59 <br /> MAJORMINOR ❑ NOVIOL. VIOL. VIOL❑ <br /> INSP: RECEIVED BY: <br /> OFFICE: <br /> c� <br /> PHONE: BECK: <br /> T '` -- <br /> - SiEB <br /> ORIGINAL <br /> -JI IT-q <br />