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UNDERGROtl&TANK PROGRAM OFFICIAL INSP- ON 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:I SP TIO DA E: �r <br />p '5T <br />SITE ADDRESS: a uE1 CITY/ST Ip L4. �LV� i J <br />�c <br />CHANGES SITE/OW ER/PERMIT? YES NO TANK TANK TANK TANK <br />FORM A AND/OR B SUBMITTED? COMPUTER ��Q COMPUTER COMPUTER COMPUTER <br />TYPE,O INSPETION JSIT NUMBER Vv NUMBER P _ QQ� NUMBER NUMBER <br />ER # `�!/S � PER # �fJ ER # PER # <br />7 77 P. DATE EXP. DATE XP. DATE EXP. DATE <br />OPERATIONAL TANK <br />MAJOR MINOR <br />PERMIT TO OPERATE 1 2 y <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 16 <br />ACCESS CASING SECURED 17 18 <br />PIPING 19 20 <br />INVENTORY RECONCILIATION 21 22 <br />TANK GAUGING 23 24 _ <br />v <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 •-----..-m�a.._.._MM..,..._ �. <br />SAFETY HAZARD 35 36 <br />CONDITIONS ABATED 37 <br />TEMPORARY TANK CLOSURE Ell <br />REMOVAL OF RESIDUAL 38 39 _ .. - _m <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 ta <br />PIPING 48 49 <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE 51 52 <br />SAMPLING 53 54 __.._ <br />IMPROPER ABANDONMENT 55 56 <br />US BE CORRECT AS <br />THE MARKED ITEMS REPRESENT VIOLATIONS ND MUS, <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS: PA01A56 -s4- _ " r <br />MAJOR 57 MINOR 58 NO IVI <br />VIOL. ❑ VIOL. ❑ VIOL.I01 <br />41 <br />OFFICE: <br />INS <br />RECEIVED RECEIVED BY: <br />x <br />0 <br />TITLE:� <br />PHONE:// <br />BECK: <br />HUT -3 ORIGINAL 5/88 0M <br />