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UNDERGROU''"1 TANK PROGRAM OFFICIAL INSPr*`TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME cN _- STOCKTOO. 46 95205 COUNTY #/11� j Z4r/j5 <br /> c.� �� PHONE NO. 468-3423 ((�J((// /� <br /> SITE NAME: Co `1 C e vi He Ina <br /> 10 KC t- INSPECTION DATE: <br /> SITE ADDRESS/0t / E '/`Qj4� DSa. CITY/STATE/ZIP Sf'�M� �/g. �.a05 <br /> CHANGES SITE/OWccNEER/PERMIT? YES NO TANK Q/ TANK 0 .3 TANK d TANK <br /> FORM A AND/OR B SUBMITTED? --of COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> 60 p� 1 PER# aA5 47 PER# .1AS ? PER# ;:LSI PER# <br /> 1 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 <br /> INVENTORY RECONCILIATION 21 122 <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 35 136 <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 /> OWNED/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE k <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 r�'yYyW_I�'GG1 lNYiGA� �r <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) FOLLOWS: <br /> MAJOR 57 M <br /> 58 NO 59 <br /> VIOL.. ❑ VIOLO.R ❑ VIOL.❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> .- , <br /> HUT-3 ORIGINAL 5/88 ©� <br />