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UNDERGROL' l TANK PROGRAM OFFICIAL INSf :TION REPORT <br />SAN JOAQUIN HEALTH DISTRIC) <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON,CA 95205 COUNTY # ? <br />PHONE NO. 468-3423 <br />SITE NAME: -7-0-YS <br />38 139 <br />47 <br />49 <br />52 <br />54 <br />56 <br />INSPECTION DATE: <br />SITE ADDRESS: 1&2_T �jM <br />G� <br />CITY/STATE/ZIP I <br />CHANGES SITE/OWNER/PERMIT? YES <br />FORM A AND/OR B SUBMITTED? <br />N <br />TANK If <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK TANK -TANK <br />COMPUTER COMPUTER <br />NUMBER NUMBER <br />PER PER <br />P. DATE DATE <br />COMPUTE <br />NUMB <br />P # <br />XP. DATE <br />TYPE OF INSPECTION <br />SITE COMPUT R # <br />D/ <br />OPERATIONAL TANK <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />TANK <br />CONTENTS <br />MAJOR MINOR <br />1 2 <br />_ <br />3 4 <br />5 6 <br />7 8 <br />- <br />9 10 <br />11 12 <br />13 14 <br />15 16 <br />17 18 <br />19 20 <br />�- <br />21 22 <br />23 24 <br />25 26�- <br />27 28 <br />29 30 <br />31 32 <br />33 34 <br />35 36 <br />u� <br />//, 37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />38 139 <br />47 <br />49 <br />52 <br />54 <br />56 <br />40 <br />41 42 <br />43 <br />44 45 <br />_ <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />46 <br />48 <br />50 <br />51 <br />53 <br />55 <br />47 <br />49 <br />52 <br />54 <br />56 <br />— <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />A/0 ;YSTEM STATUS (MUST MARK ONE) FOLLOWS: / "0 �����D�� /� - 17-tI5 -r7/yg' <br />MAJOR 57 MINOR 58 NO 59 - _Pv 5 U Z /VF <br />VIOL. ❑ VIOL. ❑ VIOLL <br />DFFICE: INSP-.e / <br />TITLE: g, <br />HUT -3 ORIGINAL <br />RECEIVED BY: <br />PHONE: <br />BECK: <br />5/88 0 rn <br />