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UNDERGROUN ANK PROGRAM OFFICIAL INSP ION REPORT ( 0 <br />JAN JOAQUIN HEALTH DISTRICT i <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # 3t7 <br />PHONE NO. 468-3423 <br />J <br />SITE NAME:I� s 1 / �/►„/�% INSPECTION DATE: �G <br />SITE ADDRESS: A& CITY/STATE/ZIP ; c7—�3 7t, <br />CHANGES SITE/OWNER/PERMIT? YES NO 1ANK <br />TANK TANK TANK <br />FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br />TYPE F INSPECTION SITE COMPUTER # NUMBER D NUMBEI�o® ��� NUMBER /0 06V UMBER <br />/�®� p�%� �J PER # �d/���.'{/ PER # PER #�S4� PER # <br />4--k " 1 / EXP DATE u LLLJJJ"` EXP. DATE EXP. DATE �N EXP. DATE <br />PERMANENT TANK CLOSURE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />MAJOR MINOR <br />PIPING <br />48 <br />PERMIT TO OPERATE <br />1 <br />2 <br />50_ <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />52 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />IMPROPER ABANDONMENT <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />FOLLOWS: 7957 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />OFFICE: <br />INSP: /a/ <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 />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 />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />41 <br />42 N� <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 REPRES T V OLATIONS AND MUST BE CORRECT D AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: 7957 <br />MAJOR MINOR a <br />VIOL. VIOL. <br />NO 5 <br />VIOL. <br />OFFICE: <br />INSP: /a/ <br />„_ . .�D , , <br />RECEIVED BY: <br />I HUT -3 <br />TITLE: le -t -W15 PHONE: <br />ORIGINAL <br />BECK: <br />5/88 <br />