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UNDERGROUM"- TANK PROGRAM OFFICIAL INSPF MOON REPORT <br /> W.AN JOAQUIN HEALTH DISTRICT u <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br />` SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: -79f &Mu r f� S7//� CITY/STATE/ZIP. <br /> t CHANGES SITE/OWNER/PERMIT? YES NO !TANK �`� TANK ?r TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # PER# PER# PER # <br /> O G EXP.DATE EXP.DATE EXP,DATE EXP.DATE <br /> OPERATIONAL TANK TANK coNTewls , <br /> MAJOR MINOR � ��..tt�t �$:4 g�z ,s � �� � �a <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 D 11 12 - <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15Y 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION -2;x <br /> 1 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 ' , T :. <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 � <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 144 45 <br /> wr <br /> PERMANENT TANK CLOSURE PA $� «' <br /> pf <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 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 2- o /-' <br /> ' � <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL. VIOL ❑ VIOL. <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> HUT-3 ORIGINAL <br />