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UNDERGROUt TANK PROGRAM OFFICIAL INSP - ON REPORT`" <br /> K <br /> ;. )AN JOAQUIN HEALTH DISTRI : . <br /> _ 1601 E. HAZELTON AVE. <br /> COUFITY NAM STOCKTON. CA 95205 <br /> PHONE"NO. 468-3423 GQU RY.# <br /> SITE NAME: INSPECTION DATE: ,.Z�- <br /> 19 <br /> SITE ADDRESS, i� G�- �/� '� rd� CITY/STATE/ZIP � (-77 9� . <br /> CHANGES SffE/O �: Y S NO TANK" =` TANK TANK TANK <br /> FORM A.AND/O SUBMITTE (� COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYP OF INSPECTION TE COMPUTER#. :; <br /> i 2 _ PER PER#`._ PER# - f, PER # <br /> v EXP.DATE- EXP.DATE EXP.DATE ^; EXP DATE <br /> OPERATIONAL TANK TANK CONTENTS ; R ,r"•' '� , `•" +•�"y � M <br /> MAJOR MINOR ' <br /> PERMIT TO-OPERATE_. 1. .2 <br /> 3 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 /> – - .; ,. <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 /> I <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD. 35 36 <br /> CONDITIONS ABATED 37 Ia <br />♦ _s ,- -- ' 4R ,-.. - .,y.4sS-rt- • x r¢F- _ - - �.ir S',ate,, "meati'''.. ' <br /> TEMPORARY TANK CLOSURE <br /> �. . <br /> ' REMOVAL OF RESIDUAL- .1.r"` 38 39 <br /> " FLAMMABLE.VAPORS REMOVED 40 ` <br /> ACCESS LOCATIONS SEALED r 41 42 <br /> P01NER DISCONNECTED. ...' ; f <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANEfO <br /> CLOSURE.EMOVAL OFREERIALS 46 47..pl4849 <br /> FLAMMABED 50 <br /> UNAUTHORIZED RELEASE 51 52. <br /> SAMPLING T. _ <br /> IMPROPER ABANDONMENT 55 56 <br /> ' THE MARKED 1. R PRES VIOLAT NS AND MUST BE CORRECTED,AS �s - <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 <br /> MINOR NO <br /> VIOL. 0 VIOL '❑ VIOL j'S <br /> OFFICE: - INSP: RECEIVED BY: <br /> PHONE. r RECK <br /> TITLE� �j* _ <br /> �.k _ j, /� 5 - .-z-, a tZZ ' r;�;. 3}_ - __"'off. �n ' 5/88•',O r <br /> HLtT-3 'ORIGINAL r r? x`: h�'I•y.' zY star ', rr`c-`•= <br />