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UNDERGROop TANK PROGRAM OFFICIAL IN CTION REPORT <br />SAN JOAQUIN HEALTH DISTRIOW <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: ��•liJ� <br />�.' L- <br />INSPECTION DATE: Z�Z, <br />oo <br />SITE ADDRESS: 5 "F0 ���..�� <br />p <br />CITY/STATE/ZIPS <br />CHANGES'SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK © <br />TANK OX, TANK O <br />TANK O <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER�j <br />COMPUTER' COMPUTER/COMPUT <br />NUMBER ADi7 NUMBEROd�'i <br />NUMBERL00 <br />TYPE OF INSPECTION SITE COMPUTER # <br />PER # <br />PER # �� <br />EXP. DATE'�1 <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK <br />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 />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE. <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />47 <br />PIPING <br />49 <br />FLAMMABLE VAPORS REMOVED <br />r5l <br />UNAUTHORIZED RELEASE <br />52SAMPLING <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />156 <br />THE MARKED ITEMS <br />REPRESENT VIOLATIONS ANQ MUST BE CORRECTED <br />AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 <br />59 <br />MAJOR 1v R Ma <br />❑ ❑ <br />❑ <br />VIOL. VIOL.. VOL. <br />OFFICE:INS-'% �<:=✓� RECEIVED BY: <br />/'4- <br />!! <br />TITLE: � P ON) � � 0�2 RECK: <br />ce0q <br />HUT-3 ORIGINAL 5/88 Ul m <br />