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UNDERGROW'� TANK PROGRAM OFFICIAL INSPP7^•TION REPORT <br /> 3AN JOAQUIN HEALTH DISTRICI <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: / cam_�3 <br /> SITE ADDRESS: CITY/STATE/ZIP l <br /> CHANGES SITE/OWNER/PEWIT? YES NO TANK / TANK Z TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER l COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPEZF INSPECTION SITE COMPUTER# PER # — PER# PER # – PER# <br /> U 1 t EXP.DATE EXP.DATE FXP DATE EXP.DATE <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 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 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 f <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 E CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: s'57 58 <br /> MAJOR MINOR NO 59r f- ✓l <br /> VIOL. VIOL. VIOL. r, ✓1 V" I i vt u!?✓i e ce lc-"lj" �40n <br /> rt— 4z - 5'3 <br /> OFFICE: INSP: GEIVED BY: <br /> TITLE: /l � 171 <br /> RE <br /> NUT-3 ORIGINAL air3a ©M <br />