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UNDERGROUP` TANK PROGRAM OFFICIAL INSP' 'TION REPORT <br /> USAN JOAQUIN HEALTH DISTRICT- <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 COUNTY # <br /> COUNTY MANIE PHONE NO. 468-3423 <br /> SITE NAME: ! SSC °� �Q�c. '//_S7 �%C INSPECTION DATE: �q �6 8g <br /> SITE ADDRESS: 365 d �� j� CITY/STATE/ZIP T g C ) <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER p COMPUTER COMPUTER COMPUTER <br /> TYPE <br /> �OFF INSPECTION SITECOMPUTER# PER BER I3/ � NUMBER NUMBER NUMBER <br /> { EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MINOR <br /> MAAJORJOR 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 - <br /> 8F-APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 <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 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 1 139 <br /> FLAMMABLE VAPORS REMOVED W43 <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <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) F <br /> MAJOR 57 MINOR 56 NO CJy� " <br /> VIOL. ❑ VIOL ❑ VIOL <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> HUT-3 ORIGINAL siee 0' <br />