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UNDERGROU/ ANK PROGRAM OFFICIAL INSP' TION REPORT <br /> -SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME J T n STOCKTON, CA 95205 COUNTY # Q9 <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: 3/- 9O <br /> Rah mCIL�'1!/7 �• <br /> SITE ADDRESS: / ra JT CITY/STATE/ZIP -�ockon / (-Z4 95�.Q o5 <br /> CHANGES SITE/O/WNER/PERMIT? YES OTANK / TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> L9 JAI EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <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 9 10 <br /> MONITORING SYSTEM 11 2 _ <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 38 39 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS [17 <br /> PIPING FLAMMABLE VAPORS REMOVED UNAUTHORIZED RELEASE SAMPLING IMPROPER ABANDONMENT <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: G <br /> 5758 59 <br /> MAJlmo <br /> VIOL UK K VIOLO.R ❑ VIOL El <br /> OFFICE: I SP: U � � <br /> �t wal 0' 11 Q[hir/�iy�Co,Sc GE#' 9520 <br /> TITLE: r HS PHO�NdEo1S ECK: <br /> HUT-3 G ORIGINAL s/m �" <br />