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UNDERGROUND TANK PROGRAM OFFICIAL INSPEl--'ON REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # � <br /> PHONE NO. 468-3423 <br /> SITE NAME: �� S 00 dam, i- INSPECTION DATE: l �I <br /> SITE ADDRESS: _�;-7174 kV, ��A r (�,,, ? CITY/STATE/ZIP f'G "7' <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK ( TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTE 00D COMPUTE COMPUTER <br /> NUMBERAtJ j NUMBER NUMBER C1 NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> PER# U -PER# •-4' �- PER# S•µ�� PER# <br /> EXP.DAT EXP.DATE �y�u� EXP.DATE t� � EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS _ <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 T <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY r2l <br /> 14 <br /> MONITORING RECORDS MAINTAINED 16 ^� <br /> ACCESS CASING SECURED 18 <br /> PIPING 20 <br /> INVENTORY RECONCILIATION 22 <br /> TANK GAUGING 23 24 _ <br /> APPROVED RESPONSE PLAN 25 26 _ <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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 REPRESENT VIOLATIONS AND MUST BE COQRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: Lea L4 _ <br /> N U 6 <br /> 6 v <br /> MAJOR 57 MINOR 58 NO 59 Z " r d <br /> VIOL. ❑ VIOL. VIOL. Com! I1/2s <br /> OFFICE: INSP: j,(/ RE ED BY <br /> TITLE: �I <br /> PHONE: / / RECK <br /> NUT-3 _ORIGINAL 5/B8 Om <br />