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UNDERGROUNTANK PROGRAM OFFICIAL INSP TION 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: �P4 INSPECTION DATE: <br /> SITE ADDRESS: Z 4Lv� CITY/STATE/ZI '* ,',-�76 <br /> CHANGES SITE/OWNE /PERMIT? YES NO TANK - TANK 6 TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTEROMPUTE COMPUTER COMPUT <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBERo NUMBER v NUMB ®(� NUMBE <br /> �r PER#,v� PER#� J PER#`�" 16 � PER# )000 D <br /> / EXP.DA EXP.DAYS EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 116 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 M� <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 139 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSUREON <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 w <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING r53 54IMPROPER ABANDONMENT 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND KWT BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) <br /> FOLLOWS: <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP1 / F7ED BY: � <br /> TITLE:� � PHONE: BECK: <br /> HUT-3 7 0✓U/ ORIGINAL 5/88 0"` <br />