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UNDERGROUNC -ANK PROGRAM OFFICIAL INSPEC' ON REPORT <br /> �,AN JOAQUIN HEALTH DISTRICT ..� <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMESTOCKTON, CA 95205 COUNTY # j 9 <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: S dnN/11 CITY/STATE/ZIP a psy-r 06 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK 2 TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTE5 COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER O�D NUMBER IDMO NUMBER �Q&WV NUMBER <br /> I PER# J PER# l PER# PER# <br /> /iJe I QZ EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJQFrI MINOR <br /> PERMIT TO OPERATE 1 f 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 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREOUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 _ __. ._ ._.._.... _. . _ ...__. _. . <br /> INVENTORY RECONCILIATION 21 122 1 _ <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 I3Q 139 <br /> FLAMMABLE VAPORS REMOVED 40r43 <br /> ACCESS LOCATIONS SEALED 41 <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING 44 <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 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 58 <br /> MAJOR 57 MINOR NO 59 --. <br /> VIOL VIOL. ❑ VIOL❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONlya BECK: <br /> HUT-3 ORIGINAL siee C <br />