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UNDFROROUFTANK PROGRAM"OFFICIAL lNSPFr ION REPORT <br /> AN JOAQ€ IN HEALTH DISTRICT ., <br /> w' 1601 E. HAZELTON AVE. <br /> STOCKTON CA 95205 <br /> COUNTY NAME PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: ' '�' / �/ -- INSPI=CTION DATE s i -�;_ <br /> 1 4 ,/ <br /> SITE ADDRESS: � � � /s CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTERy COMPUTER <br /> TYPE�INSPE,,CTION SITE COMPUTER# NUMBER/ NUMBS NUMBER �• L�� UMBER <br /> a � �� <br /> f PER# PER# A PER Aye-1 PER# <br /> V� �'�_,I 1 c EXP.DATE EXP.DATEEXP.DATE EXP.-DATE <br /> OPERATIONAL TANK TANK coNTE3dTs « � � <br /> MAJOR MINOR � � � e ; <br /> PERM;T TO OPERATE 1 2 _ <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 — � <br /> APPROVED CONSTRUCTION 5 & <br /> WRITTEN MONITORING PROCEDURES 7 8 � � � µ <br /> APPROVED MONITORING SYSTEM 9 110 <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 — Y <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 28. <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 � T �� <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 135 136 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY O`® IY TAIVK CLOSURE30 <br /> �J M `v �„' .LL 1 S'�^E 4iF T.�LL �^'k .p,. `a� °Q z:Fi ffyf Y S"K° `p�"•'1>,.. <br /> . .��».`:g. � "�„;'a`%f"�c...��;5.�r 9�`�+•.-tet���� s����". �,�.*,�,�Fc� �� � y r;'�y � 'ti , `R'2�� t <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 - <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED M43 <br /> OWNER/OPERATOR MONITORING 44 145 <br /> ' my r sR <br /> PERMANEN-r TANK CLOSURE 4 � � <br /> 3' 2r�,g • ..T` re, _ M'• ^ .z..` <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING48 49 -._..Y.-r._..,,....._.,..,...., .�...... _..�. ___._.___. m_V..._.—...w...._.......... _�_.-___._—_____.. <br /> FLAMMABLE VAPORS REMOVED 50" <br /> UNAUTHORIZED-RELEASE 51' 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRES NTV OLLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO -5-99 1 <br /> VIOL_ ❑ VIOL ❑ VIOL.LAY <br /> OFFICE:ICE: INSP: � RECEIVED BY: <br /> y <br /> TITLE: <br /> PHONE: RECK: <br /> 11 J t <br /> HUT-3 ! 0 ORIGINAL sisa n <br /> @ `i <br />