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UNDERGROfp TANK PROGRAM OFFICIAL INFMCTION REPORT <br />SAN JOAQUIN HEALTH DISTRI <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: �,;a + INSPECTION DATE: 304,42— <br />SITE <br />,,4 <br />INVENTORY RECONCILIATION 21 22 <br />TANK GAUGING 23 24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />SITE ADDRESS: <br />CITY/STATE/ZIP/,,, <br />c�► yr,► <br />CHANGES SITE/OWNER/PERMIT? <br />YES NO <br />TANK 0& <br />TANK TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />SAFETY HAZARD <br />COMPUTER <br />COMPUTER COMPUTER <br />COMPUTER <br />37 - <br />NUMBERC% <br />NUMBER NUMBER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />PER # ((/ <br />PER # PER # <br />PER # <br />FLAMMABLE VAPORS REMOVED <br />7 <br />G <br />EXP. DATE <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />43� <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />11 12 <br />- <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION 21 22 <br />TANK GAUGING 23 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 />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 - <br />53 <br />TEMPORARY TANK CLOSURE <br />IMPROPER ABANDONMENT <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 44 45 <br />PERMANENT TANK CLOSURE <br />g <br />W�RN <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />141 1 <br />PIPING <br />48 <br />49 <br />-� <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56" <br />THE MARKED ITEMS REPRESENT VIOLATIONS ANND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS: <br />57 58 59 <br />VIOL. ❑ VIOL..R ❑ VOL. ❑ <br />OFFICE: INSP:�IRECEIVED BY: <br />TITLE: PHONE: BECK: <br />HUT -3 ORIGINAL 5/88 0' <br />