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UNDERGROU'") TANK PROGRAM OFFICIAL INSP`=N 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: 16 <br /> G.ti� <br /> SITE ADDRESS: CITY/STATE/ZIPQrt.� <br /> CHANGES SITE/OWNER/PERMIT? 6fES 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 COMPUTER# <br /> PER# PER # PER# PER# <br /> EXR DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK COM34 <br /> PERMIT TO OPERATE CHANGE IN CONDITIONS TO OPERATE APPROVED CONSTRUCTION WRITTEN MONITORING PROCEDURES APPROVED MONITORING SYSTEM MONITORING SYSTEM APPROVED MONITOR FREQUENCY <br /> MONITORING RECORDS MAINTAINED 15 16 _ <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING <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 I 38 39 <br /> FLAMMABLE VAPORS REMOVED W44457 <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 El <br /> WS REPRESENT VIOLATIONS AND MUST BE CORF CTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> M58 AJOR 57 MINOR NO X59 <br /> VIOL ❑ VIOL ❑ VIOL L—I <br /> OFFICE: INSP-. p RECEIVED BY: <br /> TITLE: /� PHONE: BECK: <br /> HUT-3 ORIGINAL ae O, <br />