Laserfiche WebLink
COUNTY NAME <br />UNDERGROUTANK PROGRAM OFFICIAL INSPTION REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />6 <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: <br />/` j/ <br />24 <br />INSPECTION DATE - 3,,.? <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />PIPING <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SITE ADDRESS: <br />28 <br />CITY/STATE/ZIP <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />CHANGES SITE/OWNER/PE MIT? <br />YES <br />NO <br />TANK <br />/ <br />TANK <br />TANK ?j <br />ANK <br />IMPROPER ABANDONMENT <br />SAFETY HAZARD <br />35 <br />36 <br />2 <br />CONDITIONS ABATED <br />FORM A AND/OR B SUBMITTED? <br />37r <br />SYSTEM STATUS (MUST MARK ONE) <br />COMPUTER <br />1 <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />=�m <br />REMOVAL OF RESIDUAL <br />NUMBER <br />39 <br />NUMBER <br />NUMB ER <br />B <br />B <br />NUMB ER <br />TYPE OF INSPECTION <br /># <br />7r:fE­�UTER <br />POWER DISCONNECTED <br />PER # <br />44 <br />PER # <br />PER <br />PER <br />/ <br />L <br />/' ' <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS£ <br />., <br />MAJOR <br />MINOR <br />1� <br />1 <br />2 <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6mm <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />µms_ <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING 19 20�� <br />INVENTORY RECONCILIATION 21 22 <br />TANK GAUGING <br />23 <br />24 <br />REMOVAL OF RESIDUAL MATERIALS <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />PIPING <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />FLAMMABLE VAPORS REMOVED <br />SAMPLING <br />29 <br />30 <br />UNAUTHORIZED RELEASE <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />- <br />SAMPLING <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />IMPROPER ABANDONMENT <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />77 <br />37r <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />TEMPORARY TANK CLOSUREI'a <br />=�m <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <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�/G <br />FLAMMABLE VAPORS REMOVED <br />50� <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />- <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 <br />5n/J <br />MAJOR MINOR a VI <br />VIOL. VIOL. VIOL <br />® <br />/ 9 �%�% <br />OFFICE: INSP: RECEIVED BY: <br />TITLE: PHONE: BECK: <br />IHUT -3 ORIGINAL 5/88 O M <br />