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UNDERGROU'" ` TANK PROGRAM OFFICIAL INSP;'"TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC-, <br /> 1601 E. HAZELTON AVE. �1.. <br /> COUNTY NAME STOCKTON, CA 95205 <br /> PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: 10 <br /> INSPECTION DATE: 1 <br /> SITE ADDRESS: / CITY/STA E/ZIP7& <br /> CHANGES SITE YES NO TANK d TANK <br /> FORM A AND/OR B+SUBMITTED? COMPUTER 'S TANK o3 TANK <br /> COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER-#---��NTs NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# PER# PER# <br /> OPERATIONAL TANK TANK coN <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> MAJO MINOR <br /> PERMIT TO OPERATE 1 k 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 - — <br /> _. <br /> APPROVED CONSTRUCTION --- -- <br /> 5 6 .__.. <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM <br /> MONITORING SYSTEM 11 <br /> 12 <br /> APPROVED MONITOR FREQUENCY 13 14 " <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED <br /> PIPING 19 20 <br /> __... 1 <br /> INVENTORY RECONCILIATION <br /> TANK GAUGING <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 - <br /> SAMPLING <br /> 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> AUTHORIZED RELEASES REPORTED 33 4 <br /> SAFETY HAZARD - �! <br /> 35 36 t✓ - <br /> CONDITIONS ABATED _._... <br /> 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 — <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 v" <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING <br /> 53 54 <br /> IMPROPER ABANDONMENT <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:_..�n — <br /> (/ J <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL. ❑ VIOL.❑ Ae7 <br /> OFFICE: INSP: RECEIVED B : n/ir. Sfuvi dyjo© r� <br /> /"��c.;r w.� i'ytu t �� �o :, �?o, <br /> TITLE, f PHONE: RECK: <br /> HITT—? -�. nn��INIA I <br />