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} UNDERGRO TANK PROGRAM OFFICIAL 1NS [fQN REppRT�r � ° ' <br /> SAN JOAQUIN HEALTH DIST RI <br /> X. <br /> r <br /> 1601 E. 1-IAZELTpN AVE. !� <br /> COUNTY NAME STOCKTON, CA 95205 ! '" a ^'^ q•;�f� . <br /> PHONE NO. 468-3423 cmffff ` x <br /> SITE NAME: INSPECTION-DATE: <br /> O` <br /> SITE ADDRESS: CITY/STATE/ZIP o <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TgNK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# aA43^0I PER#P0'-_'f-?_0PER# PER <br />' 1 <br /> Kern D ilef /�/� ;2.2,(_3 <br /> EXP.DATE I EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS f <br /> MAJOR MINOR s. � <br /> T <br /> PERMIT TO OPERATE 1 2 <br />! CHANGE IN CONDITIONS TO OPERATE 3 4 ;r <br /> i APPROVED CONSTRUCTION 5 6 II <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 1 <br /> MONITORING SYSTEM 11 12 V I <br /> APPROVED MONITOR FREQUENCY 13 14 !' <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 Il <br /> PIPING 19 20 y II <br /> INVENTORY RECONCILIATION 21 22 C <br /> TANK GAUGING 23 24 it <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> i SAMPLING 29 30 <br />` APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> 4 SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> i} <br /> TEMPORARY TANK CLOSURE �� ,'. R� 3� <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 'I <br /> ACCESS LOCATIONS SEALED <br /> 41 42 <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING 44 45 <br /> I} <br /> } � s n �^ r <br /> PERMANENT TANK CLOSURE N <br /> r . <br /> tlpREO OF RESIDUAL MATERIALS 46 47NG 48 49 i1 <br /> MABLE VAPORS REMOVED 50 li <br /> UNAUTHORIZED RELEASE 51 52 !i <br /> SAMPLING 53 54 .I _ <br /> IMPROPER ABANDONMENT 55 56 I, <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS, <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: ISP I' _ "f <br /> !{ ' ''' 9L <br /> MAJOR 57 MINOR 58 NO 59Aa <br /> VIOL ❑ VIOL. ❑ VIOL <br /> li <br /> OFFICE: INSP: ' RECEIVED BY: <br /> TITLE: ,(� , l�,S. PHONE: BECK: <br /> HLIT-3 '`/ ORIGINAL 5�� 5F <br />