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UNDERGROI TANK PROGRAM OFFICIAL INS " TION REPORT <br /> :SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMEr��1 f STOCKTON, CA 95205 COUNTY # <br /> -�J 1 . [�u� �J PHONE NO. 468-3423 , <br /> f �' t <br /> SITE NAME: INSPECTION DATE:�' � .' - � ��—� � r_.i.i�«�rt � <br /> SITE ADDRESS: 2 "t ; y CITY/STATE/ZIP'1CHANGES SITE/OWNER/ <br /> TANK <br /> ORM A AND/ /OR B SUBMITTED? <br /> YES A^ NO COMPUTER TANK O COMPUTER TANK v� COMPUTER OTANK �� COMPUTER <br /> TY OF INSPECTION SITE COMP UTER# NUMBER &K NUMBER NUMBER CjK NUMBER <br /> PER# U r PER# (JC f(�';:;,? PER# < PER# <br /> EXP.DATE EXP.DATE r 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 m I <br /> APPROVED MONITORING SYSTEM 9 10 / <br /> MONITORING SYSTEM 11 12 TTT <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 W <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 M <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED VZZ, 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.MATERIALS46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 p I ye <br /> UNAUTHORIZED RELEASE 51 52 TQ ` r <br /> SAMPLING 53 54rzT�-ij � <br /> IMPROPER ABANDONMENT 155 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE ORRECTED AS <br /> SYSTEM STATUS(M ST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAJOR L MINOR NO <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: I J� i "r RECEIVED BY: <br /> a � L <br /> TITLE: 1 r-� PHONE: BECK: <br /> HUT-3 OWNER'S COPY 5/88 OM <br />