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UNDERGROUIS TANK PROGRAM OFFICIAL INSWTION REPORT <br /> > SAN JOAQUIN HEALTH DISTRICIW. U y <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # a_/ <br /> /,, PHONE NO. 468-3423 <br /> SITE NAME: e e��9 W., L INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ IP �r (�0Tc7 S— '7 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK NK TANK <br /> FORMA AND/OR B SUBMITTED? COMPUTER COMPUT�jQ�j-�', COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER#/ NJ�JIyIEIZ��-j NUMBE� NUMBER NUMBER <br /> j, / / /�+ I'E tt��ttr'vv / PER# {JO PER# PER# <br /> 1L (f y/�O! ( ( 5 EXP.DATE EXP.DATE 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 w <br /> MONITORING SYSTEM 11 12 � <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <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 35 136 _,.. <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 _ <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> ' UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54m <br /> IMPROPER ABANDONMENT 155 156 <br /> THE MARKED ITEMS RESEPII <br /> EPPRET IO TIONS AND UST BE CORREC D AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 <br /> MAJOR MINOR NO 59 <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP: J,,�' RECEIVED BY: <br /> TITLE: o d� PHONE: RECK: <br /> HUT-3 ORIGINAL 5/11 O M <br />