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UNDERGROUVc�TANK PROGRAM.OFFICIAL INSRP--j ON REPORT <br /> "N JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE, <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # � <br /> PHONE NO. 468-3423 <br /> SITE NAME: lf�? �� INSPECTION DATE: <br /> SITE ADDRESS: &03 <br /> C�f CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES �" NO TAWK j TANK TANK u l I� TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER �1 COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER # NUMBER l ,y NUMBER NUMBER NUMBER <br /> 1 / PER # PER# PER# PER# <br /> EXP.DATE EXP,DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK corrrENs ,� °. <br /> MAJOR MINOR �t .t L s a r.� .�s'r' �1 t v <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 87 <br /> TEMPORARY TANK CLOSUREfr <br /> REMOVAL OF RESIDUAL 1313 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 CLOSUREA`� <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 i <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM!STATUS(MUST MARK ONE) FOLLOWS58 <br /> : <br /> MAJOR 57 MINOR NO 59 <br /> I <br /> VIOL. ❑ VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: RECEIVED BY: 1 <br /> r <br /> TITL Z,�/11�4 PHONE: RECK: <br /> HUT-3 ORIGINAL sise 0M <br />