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UNDERGROU . TANK PROGRAM OFFICIAL INSPPRTION REPORT <br /> ' AN JOAQUIN HEALTH DISTRICT . <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 <br /> PHONE NO. 468-3423 <br /> SITE NAME:. -INSPECTION DATE:'3/ <br /> SITE ADDRESS_'. CITY/STATE%ZIP 5'_y V' <br /> CHANGES SITE/OWNER/PERMIT? YESNO TANK p} TANK p L TANK D,3 TANK <br /> COMPUTER COMPUTER ' COMPUTER COMPUTER <br /> FORM A AND/OR B. SUBMITTED?: <br /> NUMBER NUMBER NUMBER. NUMBER.. <br /> TYPE OF INSPECTION SITE COM � TER#. PER# PER# PER# PER# <br /> Ou -v j 7i EXP.DATE EXP.DATE EXP.DATE EXP' DATE <br /> TANK CONTENTS �'t •.v7` n s4- '`,•. +r `,. �. <br /> OPERATIONAL TANK K ` { <br /> MAJOR MINOR i i. <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDMONS TO OPERATE - 3 4 <br /> APPROVED CONSTRUCTION 5. 6 - <br /> WRITTEN MONITORING PROCEDURES, 7 8 <br /> APPROVED MONITORING SYSTEMS 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 <br /> . TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 3B 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS-SEALED r 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 145 <br /> PERMANENT TANK CLOSURE:. F <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 GORRECTED AS ` <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: �' <br />_ MAJOR 57 MINOR { NO; 59 j <br /> VIOL VIOL IJ VIOL <br /> OFFICE:'. INSP- RECEIVED BY: , <br /> PHONE: RECK- . i.. <br /> {2 p <br /> si88 15, <br /> :HUT-3 . "� ORIGINAL - <br />