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UNDERGROU&TANK PROGRAM OFFICIAL INSTION REPORT <br />SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE._ <br />COUNTY NAMESd STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: _ INSPECTION DATE:Y/Wrl <br />SITE ADDRESS: CITY/STATE/ZIP <br />13-?-? EXP. DATE " EXP. DATE E <br />OPERATIONAL TANK TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE 1 2 <br />CHANGES SITE/OWNER/PERMIT? YE <br />N TANK <br />TANK QZ- <br />TANK <br />TANK <br />11 12 <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />23 24 <br />APPROVED TANK REPAIRS <br />NUMBER <br />NUMBER <br />NUMBER <br />NUMBER <br />33 <br />TYPTION <br />SITE COMPUTER # <br />PER # <br />PER # <br />PER # <br />PER # <br />13-?-? EXP. DATE " EXP. DATE E <br />OPERATIONAL TANK TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE 1 2 <br />BE CORRECTED AS <br />TITLE: PHONE: RECK: <br />HUT -3 ORIGINAL 5/88 OM <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />3 4 <br />5 6 A <br />7 8 <br />9 10 <br />11 12 <br />13 14 <br />15 16 <br />17 18 <br />19 20 <br />21 2ZV <br />23 24 <br />BE CORRECTED AS <br />TITLE: PHONE: RECK: <br />HUT -3 ORIGINAL 5/88 OM <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />FZ37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />e <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <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 />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS- 42 e� <br />58 <br />59 <br />MAJOR a MINOR <br />VIOL. VIOL. J VIOL. a <br />OFFICE: <br />INSP- <br />RECEI Y: <br />BE CORRECTED AS <br />TITLE: PHONE: RECK: <br />HUT -3 ORIGINAL 5/88 OM <br />