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UNDERGROU ^ TANK PROGRAM OFFICIAL INSPF^TION REPORT <br /> . AN JOAQUIN HEALTH DISTRICT,/ <br /> 1601 E. HAZELTON AVE. Q <br /> ` COUNTY NAME STOCKTON, CA 95205 COUNTY # c! I <br /> PHONE NO. 468-3423 <br /> SITE NAM& 1141471 � INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> ! G &41 <br /> CHANGES SITE/OWNER/PERMIT? YES O TANK dl TANK b Zi TANK O3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER : NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE <br /> /COMPUTER# PER# PER# PER # PER# <br /> �!p <br /> . EXP.DATE EXP.BATE EXP.DATE EXP.DATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK <br /> MAJOR MINOR <br /> j s PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 - --- -�_-- -- <br /> 1:,{ APPROVED CONSTRUCTION g g � —_-- � ��"�""" -"�-""� --•-------__ _ <br /> WRITTEN MONITORING PROCEDURES 7 S - <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 - - --- — <br /> I`" APPROVED MONITOR FREQUENCY 13 14 - —- - <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ` ACCESS CASING SECURED 17 18 <br /> i 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 /> 1 APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 E" <br /> SAFETY HAZARD 35 36 <br /> s CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE : v <br /> REMOVAL OF RESIDUAL 38 39, <br />�;. FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> . POWER DISCONNECTED 43 <br /> I. .. OWNER/OPERATOR MONITORING 44 45 <br /> t f: <br /> PERMANENT TANK CLOSURE , <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 ! <br /> -_.----------------_�__ <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> t IMPROPER ABANDONMENT_ 55 56 <br /> THE MARKED ITEMS REP SENT IOLATIONS AN MUST BE RECTED AS <br />{, SYSTEM STATUS(MUST MARK ONE) FOLLOWS: �`!�t/ <br />{ <br />' MAJOR 57 MINOR 58 59 <br /> NO (, <br /> 4 VIOL. ❑ VIOL. ❑ VIOL.LJ <br /> OFFICE: !: INSP: D RECEIVED BY. <br /> �L� <br /> TITLE:og�11S PHONE: BECK: <br /> % H T-3 ' ORIGINAL 51M 0� <br />