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UNDERGROUN- TANK PROGRAM OFFICIAL INSPE-T)nN REPORT <br /> .: .,,J JOAQUIN HEALTH DISTRICT ..i <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME,54,j J STOCKTON, CA 95205 COUNTY <br /> PHONE NO. 468-3423 <br /> SITE NAME: U P INSPECTION DATE:<? j <br /> SITE ADDRESS: CITY/STATE/ZIP /, <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK 3 TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER # PER# <br /> I EXP.DATE EXP.DATE EXP. ATE EXP ATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR I 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 9 110 <br /> MONITORING SYSTEM 11 112 <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 23 124 <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 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 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) <br /> FOLLOWS: <br /> MAJOa MINOR Q NO j�j <br /> VIOL.R VIOL. VIOL ILI, <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> NUT-3 ORIGINAL 5/88 0M <br />