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UNDERGROU <br />rnurrY WeMF c ., . I I <br />TANK PROGRAM OFFICIAL INSP' <br />-SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 <br />PHONE NO 460._3493 <br />'TION REPORT <br />COUNTY #3 9 <br />��_.... ._....._ IV <br />• ��..� ..... ..... <br />...__ <br />INSPECTION DATE: 12-/1 gg <br />SITE NAME: <br />SITE ADDRESS:O �L <br />a <br />CITY/STATE/ZIP <br />CHANGES'SITE/OWNER/PERMIT? YES <br />NO <br />TANK 10(10 -p TANK TANK TANK <br />FORM AAND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER COMPUTER COMPUTER <br />NUMBER <br />NUMBER <br />NUMBER NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # <br />PER # 109 0 <br />PER # PER # PER # <br />L) <br />EXP. DATE <br />EXP. DATE EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />MAJORIK <br />MINOR <br />IR <br />MAJOR MINOR <br />'•r.;= <br />", : - . "' - •_ .„ ... •: <br />PERMIT TO OPERATE <br />1 <br />2 <br />_ <br />— ---- - - <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />_ <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />_ <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 />_ <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 />_ <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE. <br />- <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W4445 <br />_ <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />_ <br />PERMANENT TANK CLOSURE <br />Nor - <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />_ <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 AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 <br />5 <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL. VIOL VIOL <br />OFFICE: <br />INSP: <br />�� <br />Lej <br />RECEIVED BY; <br />TITLEI'I7'KI _ r <br />PHONE: BECK: <br />HLT -3 ORIGINAL <br />