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UNDERGROUN ANK PROGRAM OFFICIAL INSPE ION REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON,CA 95205 COUNTY # <br />CX/fifIfA) PHONE NO. 468-3423 <br />SITE NAME:CONSAj'GIf�ON <br />- L- <br />INSPECTION DATE: <br />SITE ADDRESS: f, <br />CITY/STATE/ZIP /J <br />9 -36 <br />o <br />N <br />ti <br />CHANGES SITE/OWNER/PERMIT?GIPS YES <br />NO <br />TANK <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />PER # <br />PER # <br />PER # <br />PER # <br />/ <br />N " <br />SG COQ J/ f <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANKTANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE 1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE 3 <br />4 <br />APPROVED CONSTRUCTION 5 <br />6 <br />WRITTEN MONITORING PROCEDURES 7 <br />8 <br />APPROVED MONITORING SYSTEM 9 <br />10 <br />MONITORING SYSTEM 11 <br />12 <br />APPROVED MONITOR FREQUENCY 13 <br />14 <br />_ <br />MONITORING RECORDS MAINTAINED 15 <br />16 <br />ACCESS CASING SECURED 17 <br />18 <br />PIPING 19 <br />20 <br />INVENTORY RECONCILIATION 21 <br />22 <br />TANK GAUGING 23 <br />24 <br />APPROVED RESPONSE PLAN 25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE 27 <br />28 <br />SAMPLING 29 <br />30 <br />APPROVED TANK REPAIRS 31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED 33 <br />34 <br />SAFETY HAZARD 35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL 38 <br />39 <br />FLAMMABLE VAPORS REMOVED 40 <br />ACCESS LOCATIONS SEALED 41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING 44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS 46 <br />47 <br />PIPING 48 <br />49 <br />FLAMMABLE VAPORS REMOVED 50 <br />UNAUTHORIZED RELEASE 51 <br />52 <br />SAMPLING 53 <br />54 <br />IMPROPER ABANDONMENT 55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS <br />AND MUST BE CORRECTELD. AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />r— <br />r10 <br />r%i2S <br />59� <br />r, <br />MAJOR LJ MINOR Ll <br />/) <br />VI <br />VIOL. OL. VIOL. <br />VI <br />OFFICE: <br />INSP: <br />RECEIVED BY: <br />TITLE: RE'�ts <br />PHONE: <br />RECK: <br />HUT -3 OWNER'S COPY 5/w OM <br />