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UNDERGROI TANK PROGRAM OFFICIAL INS'" TION REPORT <br /> -,AN JOAQUIN HEALTH DISTRIG� <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 5205 <br /> COUNTY NAME PHONE NO. 46893423 COUNTY # <br /> SITE NAME: CaC INSPECTIONDATE: <br /> SITE ADDRESS: r 3 a r v ol[S /STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES TAN ITANK TANK TANK <br /> FORM A AND/OR B SUBMITTED COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION ISI COMPUTER# PER#a�8O PER# PER# PER# <br /> 64�7� s EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TA NTN <br /> MAJOR MINOR <br /> _ <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 <br /> MONITORING SYSTEM 11 2 <br /> APPROVED MONITOR FREQUENCY 13 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 16 11. <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 <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W" 45 <br /> 9 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 2 <br /> POWER DISCONNECTED 3 _ <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 <br /> IMPROPER ABANDONMENT 55 J.756 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> v U U L c tis <br /> MAJOR 57 MINOR NO 59 <br /> VIOL VIOL ❑ VIOL❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: '00� PHONE: IRtgk <br /> NUT-3 ORIGINAL siea ©M <br />