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- UNDERGROLf ,TANK PROGRAM OFFICIAL INSIFrTION REPORT <br /> 'SAN JOAQUIN HEALTH DISTRIC16W <br /> 1601 E. HAZEL70N AVE. <br /> COUNTY NAME a STOCKTON, CA 95205 COUNTY # <br /> PHONE NO" 468-3423 <br /> SITE NAME: C (y�L,p J f - /` INSPECTION DATE: <br /> SITE ADDRESS: L M5 c/ &,;ze� CITY/STATE/Z1P6 <br /> CHANGES SITE/OWNE / ERMIT? YES TANK TANK TA K TANK <br /> FORM A AND/OR B SUBMITTED?- '� COMPUTER Lq j COMPUTER C MPUTER COMPUTER <br /> E OF 1NSPE SITE COMPUTER# NUMBER NUMBER MBER FPO <br /> BER <br /> ��41 EXP,DATE' EXP.DATE EXP.DATE .DATE <br /> OPERATIONAL TANK <br /> TANK conrrenRs � f ' �€ .. ., .; " s <br /> w '• " <br /> MAJOR MINOR � r�`u <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 /> ER <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 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED M 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> ZZ <br /> PERMANENT TANK CLOSURE <br /> REM OF RESIDUAL M 46 147 <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 BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59if <br /> MAJORMINOR NO <br /> VIOL ❑ VIOL ❑ VIOL <br /> OFFICE: INSP: /J �,/j„ RECEIVED BY: <br /> TITLES �&6 t�� PHONE: BECK: <br /> HUT-3 �y ORIGINAL 5/1 �' <br />