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UNDERGROUJI TANK PROGRAM OFFICIAL INS TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: � INSPECTION DATE: <br /> SITE ADDRESS: /� -- -�" /�- ��„�p CITY/STATE/ZIP �i� %' 1 .�7 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TA14K TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPiv <br /> R / COMPUTER COMPUTE COMPUTER <br /> NUMB NUMBER N NUMBER V MBER <br /> TYPEOF INSP CTI/ON SITE COMPUTER# PER# D PER ®Q PER# �oQ PER# <br /> EXP.DATE' EXP. ATE XP.DAf EXP.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 10 <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 <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 <br /> PERMANENT TANK CLOSURE <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 55 56 <br /> THE MARKED ITEWS REPRESENJIVIOLATIONS AND MUST.BE CORRECT ' A� <br /> SYSTEM STATUS(MUST MARK ONE) FOLIO X <br /> MAJOR 57 MINOR NO 59 A..,?VIOL. ❑ VIOL. ❑ VIOL. /C <br /> eA <br /> OFFICE: INSP: /„ RECEI D BY: <br /> ,, <br /> x OAA <br /> TITLE: ONE: BECK: <br /> HUT-3 ORIGINAL 5/88`0 M <br />