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UNDERGROUI\ TANK PROGRAM OFFICIAL INSPF BION REPORT <br /> -AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 5205 <br /> COUNTY NAME 14 IJ joR PHONE NO. 468-9 <br /> 893423 COUNTY #3 <br /> SITE NAME: ` C INSPECTION DATE: I/Q ka <br /> SITE ADDRESS: CITY/STATE/ZIP KI SZ <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK o TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> I 4 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK m KCON N� <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3i <br /> _ <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 23 124 <br /> APPROVED RESPONSE PLAN 25 126 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS J33 <br /> 32 <br /> UNAUTHORIZED RELEASES REPORTED 34 <br /> SAFETY HAZARD 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40Em <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED ME 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> 71 <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 REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: o_ (> og <br /> MAJOR MINOR NO 57 ir 58 5j1/ O <br /> VIOL LJ VIOL. El VIOL.LL��1f <br /> OFFICE: INSP: � RECEIVED BY: <br /> TITLE:C_tiIA ` PHONE: BECK: <br /> -TroHUT-3 ORIGINAL N 51m Or <br />