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UNDERGROUN TANK PROGRAM OFFICIAL INSP ION REPORT <br />AN JOAQUKHEA'LTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # o <br />,.� 00 U�„t---�� PHONE NO. 468-3423 <br />SITE NAME: INSPECTION DATE: �� ho <br />SAMPLING 53 54 <br />IMPROPER ABANDONMENT 55 156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS - <br />58 59 <br />57 <br />MAJ5VIOL..R ❑ VOL. ❑ <br />OFFICE: ) <br />t Ffif-3 <br />INSP:4f <br />TITLE: �', f� S` <br />SITE ADDRESS: <br />PHONE: <br />ORIGINAL. <br />CITY/STATE/ZIP ZO& <br />� ST <br />qa( f <br />OP <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK <br />TANK TANK ' <br />TANK <br />FORM A AND/OR B SUBMITTED?- <br />COMPUTER <br />COMPUTER COMPUTER <br />COMPUTER <br />NUMBER <br />NUMBER Xe NUMBER <br />��� <br />NUMBER <br />OF <br />SITE COMPUTER # <br />TYPE INSPECTION - <br />PER # �1=- <br />PER # PER # <br />PER # <br />hcBufla�� <br />Jt- <br />EXP. DATE <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />m <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />o44 <br />MONITORING RECORDS MAINTAINED <br />1W <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 j,1j, <br />22 <br />TANK GAUGING <br />2 <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 />_ww. <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34m <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />------., <br />POWER DISCONNECTED <br />43 <br />_ <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 53 54 <br />IMPROPER ABANDONMENT 55 156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS - <br />58 59 <br />57 <br />MAJ5VIOL..R ❑ VOL. ❑ <br />OFFICE: ) <br />t Ffif-3 <br />INSP:4f <br />TITLE: �', f� S` <br />RECEI <br />PHONE: <br />ORIGINAL. <br />BECK: <br />5/88 © t <br />