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UNDERGROW".TANK PROGRAM OFFICIAL INSPF''TION REPORT 4 <br /> 5AN JOAQUIN HEALTH DISTRICT <br /> I 1601 E. HAZELTON AVE. <br /> CRUNTY NAME STOCKTON, CA 95205 COUNTY.# <br /> PHONE NO. 468-3423 <br />{ SITE NAME: INSPECTION DATE:�Z � <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> Z-, -S <br /> CHANGES SITE/OWNER/PERMIT? YES TANK TANK . TANK" ' TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER 'COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> J S fI � PER# PER # PER # PER# <br /> r EXP.DATE' EXP.DATE EXP,DATE EXP.DATE <br /> M ON <br /> OPERATIONAL TANK mNs<coNTeNTs . <br /> MAJOR .WII NOR ,. .. _. .° _ e � '. EM <br /> . .. <br /> PERMIT TO OPERATE 1 2. <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 1 8. _ v � <br /> APPROVED MONITORING SYSTEM 9 110 <br /> MONITORING SYSTEM 11. 112 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> ' <br /> INVENTORY RECONCILIATION 21 <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 /> I CONDITIONS ABATED 37 e <br /> TEMPORARY TANK CLOSURE <br /> « <br /> W-1 <br /> gi � <br /> e <br /> REMOVAL OF RESIDUAL 38 139 <br /> 9 FLAMMABLE VAPORS REMOVED 40 v W._. �^ ..M.............,.�...__..._....._ <br /> '- ACCESS LOCATIONS SEALED 41 42. <br /> � POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45IWH <br /> I <br /> gg <br /> i <br /> PERMANENT TANK CLOSURE r. � , <br /> ' . <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 s __ <br /> UNAORIZED RELEASE 51 52 <br /> LING 53 54 v,w..._W.._. _._�_._.__. �............ ....� <br /> IMPROPER ABANDONMENT" 55 5$ <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) <br /> FOLLOWS: «— <br /> 57 58 59 <br /> MAJOR NO <br /> VIOL. ❑ VIOLL..R ❑ VIOL.❑ <br /> I <br /> OFFICE: INSP: RECEIVED BY: <br /> a <br /> r TITLE: PHONE: BECK: <br /> HUT-3 ORIGINAL siaa 0M <br />