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UNDERGROUW TANK PROGRAM OFFICIAL INSPF" ION REPORT 16F3 <br /> ,.oAN JOAQUIN HEALTH DISTRICT �,• — <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 <br /> PHONE NO. 468-3423 <br /> SITE NAME: �F G��NSE �� U'? �� INSPECTION DATE: <br /> SITE ADDRESS: 6 SO v C/)RI S CITY/STATE/ZIP . [� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK 3 TANK 3 TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTER 5j COMPUTER COMPUTER <br /> NUMBER NUMBER /�o NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> /WArs'Aw v'G / .4-30Q, <br /> 3� PER# PER # PER# PER# <br /> I/ 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 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 W4445 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> 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 REPRESErJ.T VIOLATIONS AND MUS BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: (!/- J / S <br /> 57 58 59 <br /> MAJORMINOR NO <br /> VIOL. ❑ VIOL. ❑ VIOL <br /> Ae <br /> 574,2 006'a pop '4 <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: Qs O PHONE: RECK: <br /> HUT-3 /` ORIGINAL 51N <br />