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UNDERGROU TANK PROGRAM OFFICIAL INS TION REPORT <br />WSAN JOAQUIN HEALTH DISTRIC'f <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: <br />25 <br />26 <br />RE ATERIALS <br />UNAUTHORIZED RELEASE OCCURRENCE <br />INSPECTION DATE: <br />SITE ADDRESS: ��j$ �%� <br />PIPING <br />CITY/STATE/ZIPCt'�Gf� <br />ZOZZ37 <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK O <br />TANK <br />TANK <br />UNAUTHORIZED RELEASES REPORTED <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />SAMPLING <br />SAFETY HAZARD <br />COMPUTEP <br />COMPUTER <br />COMPUTER <br />CONDITIONS ABATED <br />COMPUTER <br />37 ���� <br />NUMBER <br />NUMBER <br />NUMBER <br />REMOVAL OF RESIDUAL <br />NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # <br />/ olgvvpk 1 <br />FLAMMABLE VAPORS REMOVED <br />PER # <br />EXP. DATE <br />PER # <br />EXP. DATE <br />PER # <br />EXP. DATE <br />41 <br />PER # <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <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 />_d <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />A4T <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY 13 14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED 17 18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION 21 22� <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />RE ATERIALS <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />PIPING <br />SAMPLING <br />29 <br />30 <br />FLAMMABLE VAPORS REMOVED <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASE <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAMPLING <br />SAFETY HAZARD <br />35 <br />36 <br />----- ---- <br />IMPROPER ABANDONMENT <br />CONDITIONS ABATED <br />155 <br />37 ���� <br />TEMPORARY TANK CLOSURE <br />SYSTEM STATUS (MUST MARK ONE) <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />M <br />ACCESS LOCATIONS SEALED <br />41 <br />42 w m, ..,. <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />(OFFICE: (INSP: 0w&�i�- (RECEIVED BY: <br />TITLE: A -o- d-5, PHONE: BECK: <br />HUT -3 ORIGINAL 5/88 0M <br />�ERMANENT TANK CLOSURE <br />RE ATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />155 <br />156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: -5kw- Ma <br />57 58 <br />59 <br />VIOL.. MAJOR MINO'❑ VIOL. ❑ <br />VOL. ❑ <br />(OFFICE: (INSP: 0w&�i�- (RECEIVED BY: <br />TITLE: A -o- d-5, PHONE: BECK: <br />HUT -3 ORIGINAL 5/88 0M <br />