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r UNDERGROUPTANK PROGRAM OFFICIA INSPE^TION REPORT <br /> 99 . SAN JOAQUIN HEALTH DISTRICIi -1 2-43-Q 2, <br /> 4 1601 E. HAZELTON AVE. <br /> z COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 h <br /> u <br /> SITE NAME: . SCAV <br /> U/ 'Dis _ I't INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> pN . f�cuc<a ,, C <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER#22Y3-02 PER# PER# PER# <br /> ifec Ir4-pot 0 1 <br /> X�DATE'` � EXP.DATE DDATE. � EXP.DATE EXP.DATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK <br /> Y <br /> MAJOR MINOR " <br /> PERMIT TO OPERATE 1 2 li <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 ,f <br /> WRITTEN MONITORING PROCEDURES 7 8 i! <br /> APPROVED MONITORING SYSTEM 9 10 i- <br /> MONITORING SYSTEM 11 12 If <br /> APPROVED MONITOR FREQUENCY 13 14 :l I <br /> MONITORING RECORDS MAINTAINED 15 16 sl <br /> 1 ACCESS CASING SECURED 17 18 1? <br /> s <br /> PIPING 19 20 li <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 it l <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 1 <br /> SAMPLING 29 30 ) <br /> APPROVED TANK REPAIRS 31 32 i,'. <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE � � I1 � " a' <br /> .� <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 If _ <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECT 43 <br /> OWNE ER MONITORING 44 45 <br /> I} <br /> � �f -:,mw w RMANENT TANK CLOSUR a ��� <br /> REMOVA RESIDUAL MATE 46 47 !' <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 r, }} <br /> IMPROPER ABANDONMENT 55 56 Ii 1 <br /> THE MARKED ITEMS REPRESENT VIOLATIONSA D MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: �CSSCOF I! i - <br /> f 7o r <br /> f MAJOR 57 MINOR 58 NO 512, II ,� <br /> I VIOL ❑ VIOL LiVIOLS <br /> I <br /> q - <br /> OFFICE: INS RECEIVES BY: <br /> 'i <br /> TITLE: PHONE: BECK: <br /> ♦� I4 <br /> HUT--3 ORIGINAL '} 5188 OM <br /> L I' <br />