Laserfiche WebLink
UNDERGROUN ANK PROGRAM OFFICIAL INSPEfON REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME <br />STOCKTON, CA 95205 <br />PHONE NO. 468-3423 <br />COUNTY <br />7 <br />OPERATIONAL TANk <br />SITE NAME;4`S� Q/ <br />/ �'3 <br />1 <br />INSPECTION DATE:�� <br />SITE ADDRESS: <br />3 <br />CITY/STATE/ZIP <br />APPROVED CONSTRUCTION <br />7 <br />CHANGES SITE/OWNER/PERMIT? <br />YES NO TANK 3 <br />TANK <br />TANK °S <br />TANK <br />FORM A AND/OR B SUBMITTED? COMPUTE <br />NUMBER <br />TYP F INSPECTION SITE COMP T R # <br />j) PER # Z-� <br />COMPUTER <br />NUMBER <br />14C <br />PER #,-2 o" / <br />COMPUTER COMPUTER If <br />NUMBER <br />PER # 17j�jd <br />COMPUTEF& , <br />NUMBER ` <br />p <br />PER # -Z <br />d yi,oi e- AIWOL2, <br />/ <br />EXP. DATE EXP. DATE 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 />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />110 <br />11 <br />12� <br />MONITORING SYSTEM <br />13 <br />14 <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />17 <br />18 <br />ACCESS CASING SECURED <br />PIPING <br />19 <br />20 <br />21 <br />22 <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 w <br />SAMPLING <br />29 <br />30 <br />31 <br />32 <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />134 <br />SAFETY HAZARD <br />35 <br />136 <br />CONDITIONS ABATED <br />/ <br />37�� <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />PERMANENT TANK CLOSURE <br />38 <br />139 p p <br />FLAMMABLE VAPORS REMOVED <br />REMOVAL OF RESIDUAL MATERIALS <br />40 <br />46 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />49 <br />43 <br />OWNER/OPERATOR MONITORING <br />50 <br />44 <br />45 <br />AS <br />5/88 © i <br />PERMANENT TANK CLOSURE <br />gamonamomimm <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 />153 <br />154� <br />IMPROPER ABANDONMENT <br />155 <br />156 y� <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE <br />SYSTEM,STATUS (MUST MARK ONE) <br />FOLLOWS: <br />MAJOR 57 MINOR 58 <br />VIOL. Li❑ <br />NO <br />VIOL. IN <br />59 <br />I <br />OFFICE: <br />INSP: <br />RECEIVE Y: <br />6 <br />�� A <br />/) <br />� <br />� <br />PHONE• <br />BECK: <br />TITLE: <br />HUT -3 <br />ORIGINAL <br />AS <br />5/88 © i <br />