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- 0 WP30c-w- OO Speediset0" MCPOO Patented 407 <br />UNDERGROUND TANK PROGRAM OFFICIAL INSPECTION REPORT <br />SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />0392 <br />SITE NAME: <br />TANK CONTENTS <br />MAJOR MINOR <br />1 2 <br />3 4 <br />5 6 <br />INSPECTION DATE: <br />SITE ADDRESS:�?d'3 <br />x;� eq4y- <br />13 14 <br />CITY/STATE/ZIP <br />G�Q <br />19 20 <br />CHANGES SITE/OWNER/PERMIT? YES NO <br />TANK <br />24 <br />TANK <br />TANK <br />TAN K <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER � <br />EXP. DA <br />© <br />156 <br />COMPUTER <br />NUMBER <br />EXP. DATE <br />COMPUTER <br />NUMBER <br />PER# 0 <br />EXP. DATE <br />COMPUTER . <br />NUMB <br />PER #E5 <br />EXP. DATE <br />E OF INSPE ION <br />lomov" <br />CO�P�T <br />l3q- <br />OPERATIONAL TANK <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />TANK CONTENTS <br />MAJOR MINOR <br />1 2 <br />3 4 <br />5 6 <br />7 8 <br />9 10 <br />11 12 <br />13 14 <br />15 16 <br />17 18 <br />19 20 <br />21 22 <br />23 <br />24 <br />25 26 <br />27 28 <br />29 30 <br />31 32 <br />33 34 <br />35 36 <br />/ 37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 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 />156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />57 58 59 <br />MAJORINIj <br />VIOL. LJLL VIOR ❑ VOL. ❑ <br />OFFICE: INSP RECEIVED BY: <br />TITLE: PHONE: BECK: <br />ORIGINAL <br />5/88 <br />