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UNDERGROUt TANK PROGRAM OFFICIAL INSPF-TION RFPM-V <br />- SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 <br />PHONE NO. 468-3423 COUNTY # <br />139 <br />SITE NAME: v <br />scj"Y� <br />INSPECTION DATE: //-H -Fp <br />SITE ADDRESS: <br />CITY/STATE/ZIP <br />/ &-%.7/ C19 <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO <br />TANK 0 <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />ie -D <br />PER # <br />PER # <br />PER # <br />PER # <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />�NK <br />--------- <br />CONTE� <br />7 <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />1-6— <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />fo— <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />-25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />8 <br />2� <br />q30 <br />SAMPLING <br />9 <br />0 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL I <br />38 <br />139 <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />1 <br />W43 <br />42 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />44 <br />457 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS- Cqlee- all, <br />57 58 59 <br />Lj MINORE] NO E] <br />❑ <br />V IOL VIOL VIOL <br />OFFICE: <br />INSP:�, <br />RECEIVED BY: <br />TITLE: <br />Ki <br />S <br />PHONE: <br />RECK: <br />HUT -3 ORIGINAL 5/w (F). <br />