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UNDERGROU�TANK PROGRAM OFFICIAL INSP�ION REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: <br />INSPECTION DATE: <br />SITE ADDRESS: <br />CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK TANK <br />TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER COMPUTER <br />COMPUTER COMPUTER <br />NUMBER NUMBER <br />NUMBER NUMBER <br />TYPE OFINSPECTION_ SITE COMPUTER #�. <br />n �V�ps <br />_ <br />PER # ��/sy�y PER # �ysy <br />PER # PER # <br />/45 <br />y <br />I EXP. DATE I EXP. DATE <br />EXP. DATE I EXP. DATE <br />PERATIONAL TANK <br />TANK <br />CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />_ <br />7---=- <br />_ <br />APPROVED CONSTRUCTION <br />5 <br />- <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />- <br />APPROVED MONITORING SYSTEM <br />9 <br />10' <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />34 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <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 />128 <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 />.. <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 1 <br />48 <br />49 <br />_w <br />FLAMMABLE VAPORS REMOVED <br />50.M.rv,_ <br />UNAUTHORIZED RELEASE 51 52 <br />SAMPLING 53 54 <br />IMPROPER ABANDONMENT 55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS: 44 r nc <br />r> _ <br />57 58 59 <br />MAJOR MINOR ❑ NO n <br />VIOL. ❑ VIOL. VIOL. ❑ <br />OFFICE: INSP:�/ RECEIV <br />TITLE: , H� �� P E: BECK: <br />3y�� <br />HUT -3 ORIGINAL 5/88 <br />