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UNDERGROUI&TANK PROGRAM OFFICIAL INSP�TION REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME,&,�- STOCKTON, CA 95205 COUNTY # <br />Q PHONE NO. 468-3423 <br />SITE NAME:p INSPECTION DATE: /71 <br />SITE ADDRESS: CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? YES NO TANK 0f TANK 0;L, TANKO TANK p c f <br />FORM A AND/OR B SUBMITTED? COMPUTES COMPUTER COMPUTER COMPUTER <br />NUMBER NUMBER NUMBER NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # PER # PER # PER # ]PER # <br />m LOT= <br />TITLE: <br />VIOLATIONS AND MUST BE <br />B_E CORRECTED AS� <br />�x^'C.l.-I` C <br />v I ..1 <br />tL , 71 KIM M��l i , <br />I114-00 4-6 <br />HUT -3 ORIGINAL 5/88 ©" <br />r ®"Ill �- <br />i <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 />_ <br />m, A�►/� a <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />110 <br />MONITORING SYSTEM <br />11 <br />12 <br />; <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 <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 />40 <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 />at <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 />156 <br />THE MARKED ITEMS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 <br />59 <br />MINOR <br />MAJOR NO <br />❑ LiVOL. <br />VIOL. VIOL. <br />Af e <br />m LOT= <br />TITLE: <br />VIOLATIONS AND MUST BE <br />B_E CORRECTED AS� <br />�x^'C.l.-I` C <br />v I ..1 <br />tL , 71 KIM M��l i , <br />I114-00 4-6 <br />HUT -3 ORIGINAL 5/88 ©" <br />