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UNDERGROUP-l') TANK PROGRAM OFFICIAL INSPECTION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC",..,, <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME,dr f j Ili. STOCKTON, CA 95205 COUNTY # <br /> 2. PHONE NO. 468-3423 <br /> SITE NAME: o /i�= 1 1�NDATE:lb <br /> G ;. <br /> SITE ADDRESS: [� �j� CITY/STATE/ZIP <br /> CHANGES SITE YES '- NO TANK of TANK TANK TANK L{� <br /> FORM A AND/OR B SUBMITTED? S e f COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER Jf <br /> f PER# PER # R# P # <br /> ! EXP.DATE EXP.DATE XP.DATE P.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 V 112 V <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 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD 3536 y <br /> CONDITIONS ABATED 37 r 1 <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 4 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS UST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. V10L. ❑ VIOL❑ ._ <br /> OFFICE: INSP:f: .� fh t r RECEIVED BY: <br /> TITLE , / f f.- PHONE: RECK: <br /> HUT-3 i FILE COPY <br />