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UNDERGROU► ' TANK PROGRAM OFFICIAL INSPr-TION REPORT <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: f / �/ �C�� / r = INSPECTION DATE: S <br /> u" <br /> SITE ADDRESS:I S CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK ,/1 Z TANK , • TANK �� <br /> FORM A AND/OR B SUBMITTED? ( � COMPUTED'' COMPUT R COMPUTER COMPUTER"` <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE OMPUTER# <br /> l �! --� PER# PER# PER# PER# <br /> /i ' ' �"` x.� / EXP.DATE 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 �1 64 � _ <br /> INVENTORY RECONCILIATION 21 22 J/' c� r <br /> TANK GAUGING 23 24-- <br /> APPROVED <br /> 4--APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27L" 28 <br /> SAMPLING 29 j/ 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 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 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 ME I <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 155 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) <br /> FOLLOWS:, <br /> 57 58 59 <br /> MAJOR M <br /> VIOL. ❑ VIOL..R ❑ VOL.❑ <br /> OFFICE: INSP: , RECEIV BY: <br /> TITLE:fr PHONE: BECK: <br /> HUT-3 FILE COPY 5/88 0M <br />