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UNDERGROUV`rTANK PROGRAM OFFICIALS INSPF-T-rm REPORT <br /> -AN JOAOUIN HEALTH DISTRIC-N, <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> u rAIN + PHONE NO. 468-3423 39 <br /> SITE NAME: <br /> H<45k y cro eINSPECTION DATE: <br /> ail <br /> SITE ADDRESS: <br /> ,2373 CITYfSTATE/ZIP <br /> art xtc� �7oCk�d�r C� <br /> CHANGES SITE/OWNER/PERMIT?' YES <N0 TANK TANK'I 2 TANK TANK <br /> FORM AAND/OR B SUBMITTED? rJ O COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE pF INSPECTION SITE COMPUTER# NUMBER NUMBER. NUMBER NUMBER <br /> ( Sr...,,I31r - I-� PER# PER#'', PER# PER# <br /> •/ EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> Ig`OPERATIONAL TANK TANK CONTENTS -' <br /> MAJOR MINOR ;, +,'��1•s`R `� n�. 'i W. �., <br /> .._.. .. <br /> PERMIT TO OPERATE 1 2 u <br /> CHANGE IN CONDITIONS TO OPERATE <br /> APPROVED CONSTRUCTION 5 8 - <br /> WRITTEN MONITORING PROCEDURES <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 39 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 "— <br /> it <br /> ..�`::: -- 3. <br /> TEMPORARY TANK CLOSUREggrgg <br /> ma <br /> ° <br /> W <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 _ _...._ <br /> ACCESS LOCATIONS SEALED 41 142 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE y � 4 � it <br /> REMOVAL OF RESIDUAL MATERIALS r53 <br /> 47 WON <br /> PIPING 49 0 <br /> FLAMMABLE VAPORS REMOVED i*'� <br /> UNAUTHORIZED RELEASE 52 <br /> SAMPLING 54IMPROPER ABANDONMENT 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE C/ORRECTE/D�AS ' <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS; -�n' fincj G�c7-r/x' 'TiT{ 2"< r 'RTZ <br /> 57 58 NO 59 <br /> VIOL R ❑ VIIOLR LJ VIOL.®/ <br /> OFFICE: INSP: /' L RECEIVED BY: <br /> TITLE. PHONE: ; RECK: <br /> I <br /> HUT-3 OWNER'S COPY srea ©M <br />