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UNDERGROU� TANK PROGRAM OFFICIAL INSPF`TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 <br /> COUNTY NAME PHONE NO. 468-3423 COUNTY # 3 <br /> SITE NAME: S 5 F� ��� �� INSPECTION DATE/6 F,7/� <br /> SITE ADDRESS: - V'ki4, ` CITY/STATE/ZIP�1— —S-3- G <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK ITANK <br /> FORM RAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBEFj O C2 NUMBER NUMBER NUMBER <br /> PER# O/U est PER# PER# PER# <br /> Ro V& I EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 137 2 <br /> CHANGE IN CONDITIONS TO OPERATE 4 <br /> APPROVED CONSTRUCTION 6 <br /> WRITTEN MONITORING PROCEDURES 8 <br /> APPROVED MONITORING SYSTEM 10 <br /> MONITORING SYSTEM 12 <br /> APPROVED MONITOR FREQUENCY 14 <br /> MONITORING RECORDS MAINTAINED 16 <br /> ACCESS CASING SECURED 18 <br /> PIPING 20 <br /> INVENTORY RECONCILIATION 22 <br /> TANK GAUGING 24 <br /> APPROVED RESPONSE PLAN — _ <br /> UNAUTHORIZED RELEASE OCCURRENCE 28 <br /> SAMPLING 30 <br /> APPROVED TANK REPAIRS 32 <br /> UNAUTHORIZED RELEASES REPORTED 34 <br /> SAFETY HAZARD 36 <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 WOMEN <br /> ACCESS LOCATIONS SEALED 41 142 <br /> POWER DISCONNECTED 43 _ <br /> OWNER/OPERATOR MONITORING 44 145 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: Z— O G Z— <br /> J <br /> 58 <br /> MAJOR 57 MINOR NO 59 <br /> VIOL VIOL ❑ VIOL❑ <br /> Of <br /> OFFICE: INSP: RECEIVED BY: n <br /> P <br /> TITLE: je6Y5 PHONE: RECK: <br /> Zo - V4 <br /> HUT-3 ORIGINAL sine O» <br />