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UNDERGRO"VI^ TANK PROGRAM OFFICIAL IN' /'ION REPORT <br /> . AN JOAQUIN HEALTH DISTRI .l <br /> 1601 E. HAZELTON AVE. <br /> l STOCKTON, CA 95205 COUNTY # 3°J <br /> COUNTY NAME��1 PHONE NO. 468-3423 <br /> SITE NAME: ' ( cep INSPECTION DATE: (-Llwla <br /> SITE ADDRESS: ' CITY/STATE/ZIPI <br /> CHANGES SITE/OWNER/PERMIT? YES N TANK z TANK 3 K <br /> FORM AAND/OR B SUBMITTED? COMP COMPUTER PUTER <br /> NUMBER NUMBER BER <br /> TYPE OF INSPECTION pp SITE COM ER# PER# PER# # <br /> r4 I S EXP.DATE EXP_DATE -DATE <br /> OPERATI A ANK TAKK CON N� <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 - - <br /> CHANGE IN CONDITIONS TO OPERATEAPPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> 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 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED ME 43 _ <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS lif7 <br /> PIPING <br /> FLAMMABLE VAPORS REMOVED UNAUTHORIZED RELEASE SAMPLINGIMPROPER ABANDONMENT <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS " <br /> SYSTEM STATUS(MUST MARK ONE) 59� FOLLTIe UZ-ZIA . <br /> MAJOR57 58 MINOR NO pl (b i <br /> VIOL VIOL. VIOL CJ <br /> a <br /> OFFICE: INSW /A RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> HUT-3 ORIGINAL siee <br />