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�s UNDERGROU0 TANK PROGRAM OFFICIAL INSTION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br /> s o <br /> SITE ADDRESS: ^ CITY/STATE/ZIP <br /> /'�v5 e f om.moi. S C ee lesY, <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 COMPUTERR## PER # /YffS-O7 PER# fV8S-O�- PER# /V YS-6-3 PER # <br /> ieo"71/i� �y f3 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TAN- NFM rs <br /> MAJO0RR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 14 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 _ <br /> APPROVED MONITORING SYSTEM 9 <br /> MONITORING SYSTEM 11 112 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 ' <br /> ACCESS CASING SECURED 17 18 _ <br /> PIPING 19 20 -..... _ - <br /> INVENTORY RECONCILIATION 21 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 W43 <br /> FLAMMABLE VAPORS REMOVED _ <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> a,Ati <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 <br /> CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: /^, /" �' '/l^''� �`''� '�"�• <br /> MAJOR 57 MINOR V <br /> NO 59VIOL. VIOL. VIOL.❑ <br /> OFFICE: INSP: Cueo/ RECEIVE <br /> TITLE: J?ggS PHONE: BECK: <br /> wl'T-Z nRIGINAL. siea Om <br />