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UNDERGROU*TANK PROGRAM OFFICIAL INSPl ION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY #3 <br /> PHONE NO. 468-3423 <br /> SITE NAME: e INSPECTION DATE: <br /> SITE ADDRESS: pI J CITY/STATE/ZIP* Z.031, CLo <br /> CHANGES SITE/OW(NER/PERMIT? YES NO TANK / Q TANK�_ TANK3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER&W COMPUTER COMPUT <br /> NUMBER NUMBER ��•% NUMBER NUMB <br /> TYPE OF INSPECTION SITE7COMPUTER# PER#�O100" PER# /0 QOG PER# 3o o PE # <br /> EXP.DATE EXP.DATE EXP.DATE XP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <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 9 110 <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 <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 � �✓ -��� ..�.._. .�. .,_.._.�u.�.. �M <br /> TEMPORARY TANK CLOSURE <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 44 45 _...._ __ ..,..M <br /> PERMANENT TANK CLOSURE NINE= <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 155 156 � <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. ❑ VIOL El 58 <br /> OFFICE: INSP: ��x RECEIVED BY: <br /> TITLE: ��Ls` PHONE: BECK: <br /> HUT-3 ORIGINAL 5/88 ©� <br />