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UNDERGROU <br />WSAN <br />TANK PROGRAM OFFICIAL INSP TION REPORT <br />JOAQUIN HEALTH DISTRICT,q <br />50 ME <br />51 52 <br />53 54 <br />1601 E. HAZELTON AVE. <br />iYSTEM STATUS (MUST MARK ONE) <br />MAJOR 57 MINOR 58 NO 59 <br />VIOL. ❑ VIOL. ❑ VIOL. <br />COUNTY NAME <br />STOCKTON, CA 95205 <br />COUNTY #� <br />I <br />PHONE NO. 468-3423 <br />SITE NAME: <br />INSPECTION DATE: I C <br />2±1 r <br />E <br />SITE ADDRESS- � CoL) <br />07W <br />CITY/STATE/ZIP 3,1�70o <br />CF) 9 <br />`--TANK <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO <br />TANK TANK 2- <br />TANK 3 <br />FORM AAND/OR B SUBMITTED? <br />COMPUTER COMPUTER <br />NUMBER IOybOb NUMBER 10 Ci Q <br />COMPUTER <br />NUMBER IC)} CO <br />COMPUTER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE COMPUTER <br /># <br />PER # Rix PER # U,L, <br />PER # (j L, <br />PER # <br />i <br />EXP DATE EXP DATE <br />EXP DATE <br />EXP DATE <br />OPERATIONAL TANK <br />TANK coNn <br />, <br />` <br />NSA3{)R <br />MINOR <br />� �^k����,�: ���. <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />{ <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />126 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />- <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />-- <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 <br />- - <br />OWNFR/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />46 47 <br />48 49 <br />50 ME <br />51 52 <br />53 54 <br />55 56 <br />iYSTEM STATUS (MUST MARK ONE) <br />MAJOR 57 MINOR 58 NO 59 <br />VIOL. ❑ VIOL. ❑ VIOL. <br />OFFICE: <br />HUT -3 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE <br />FOLLOWS: <br />INSP: r/ . 77 <br />TITLE: <br />'Pe e (H-9 <br />ORIGINAL <br />RECEIVE BY: <br />PHONE.: <br />BECK: <br />i11CTED AS <br />s/88 ® t <br />