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COUNTY NAME <br />UNDERGROUtTANK PROGRAM OFFICIAL INSP�ION REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME:ent) <br />INSPECTION DATE: �� g <br />n-tru <br />U <br />SITE ADDRESS: Z6-i-2 <br />G-i-Cco <br />Y <br />o` <br />CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />No <br />TANKSI q^ <br />TANK TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER l7' w. <br />COMPUTER COMPUTER <br />COMPUTER <br />NUMBER L)J,C), <br />NUMBER NUMBER <br />NUMBER <br />T E OF INSPECTION <br />SITE COMPUTER # <br />PER #j`^'0 <br />PER # PER # <br />PER # <br />l 0_=�o <br />EXP. DATE <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK <br />CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />_ <br />SAMPLING <br />30 <br />N <br />_- <br />APPROVED TANK REPAIRS <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />E35 <br />34 <br />SAFETY HAZARD <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />q43 <br />ACCESS LOCATIONS SEALED <br />41 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />44 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />47 <br />PIPING <br />F50 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE 51 52 <br />SAMPLING 53 54 p <br />IMPROPER ABANDONMENT 55 56� <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS: S�2c� C410 <br />MAJOR 57 MINOR 58 NO 59 <br />VIOL. ❑ VIOL. ❑ VIOL. <br />(OFFICE: EINSP: <br />TITLE: <br />IHUT -3 ORIGINAL 5/88 c <br />