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UNDERGRO D TANK PROGRAM OFFICIAL INS CTION REPORT <br />SAN JOAQUIN HEALTH DISTRI* <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: S' J c c a u // <br />INSPECTION DATE: <br />�p �l <br />G�-ze <br />ct <br />SITE ADDRESS: <br />l /c� /.:F.l7<r <br />� � n <br />CITY/STATE/ZIP <br />Ccs. <br />CHANGES SITE/OWNER/PERMIT? YES NO <br />TANK <br />TANK TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER COMPUTER COMPUTER <br />BER <br />NUMBER NUMBER NUMBER <br />TYPE OF INSPECTI N "N CpMPUTER # <br />PER l/Yl PER # PER # PER # <br />l C Y r <br />K n+ <br />I <br />EXP. DATE <br />EXP. DATE EXP. DATE EXP. DATE <br />OPERATIO AL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 110 <br />MONITORING SYSTEM <br />11 12 <br />1 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD <br />35 36 <br />µm - <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />~~R µ rr M ~~~ <br />ACCESS LOCATIONS SEALED <br />41 42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />- <br />PIPING <br />48 49~ <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />53 54 <br />IMPROPER ABANDONMENT <br />155 156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />LLOWS: <br />l _ X4. ,a`L <br />< An S <br />57 58 <br />59 <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL. VIOL. VIOL <br />OFFICE: <br />INSP: <br />RECEIVED BY: <br />TITLE: <br />PHONE: <br />BECK: <br />HUT -3 ORIGINAL 5/88 0< <br />