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UNDERGROUNTANK PROGRAM OFFICIAL INSP ON REPORT///? /a/-- 3 <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: INSPECTION DATE: <br /> SITE ADDRESS: ?-` 0 Al, 6111140CITY/STATE/ZIP44 <br /> CHANGES SITE/OWNER/PERMIT? YES/ NO 1ANK TANK 2_ TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> / � ® PER # PER# PER # PER# <br /> Alk 6v -z EXP.DATE EXP.DATE EXP DATE EXP DATE <br /> OPERATIONAL TANK TANK CONMNTS <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 r2l <br /> 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 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 13. 39 <br /> FLAMMABLE VAPORS REMOVED W4446 <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> i <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 AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAJOR MINOR NO 77t 40 <br /> VIOL. ❑ VIOL ❑ VIOL <br /> OFFICE: INSP:� RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> HUT-3 OWNER'S COPY 5/8e OM <br />