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UNDERGROU&TANK PROGRAM OFFICIAL INSTION REPORT <br />AN JOAQUIN HEALTH DISTRICTW <br />�4w" 1601 E HAZELTa <br />COUNTY NAME/ j� f <br />""� °✓ <br />NAVE. <br />STOCKTON, CA 95205 <br />PHONE NO. 468-3423 <br />COUNTY <br />SITE NAME:, /�� <br />►/ 00L13 -&// <br />5 6 <br />INSPECTION DATE: <br />SITE ADDRESS: '% ��'� /�-,�j <br />CHANGES SITE YE O <br />FORM A AND/OR B SUBMITTED? f' - <br />/ <br />TANK �� <br />COMPUTER <br />NUMPER BER P� <br />EXP. DATE <br />CITY/STATE/ZIP <br />TANK oz_TANK <br />COMPUTERCOMPUTER <br />PER BER + <br />EXP. DATE <br />TANK <br />93 COMPUTER <br />NUMBER "W' PER NUMBER <br />PER # VWl <br />EXP. DATE EXP DATE <br />TY E 0 ;2PECTION <br />SITE COMPUTER # <br />%!L <br />l <br />OPERATIONAL TANK <br />PERMIT TO OPERATE <br />HANGS IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />TANK CONTENTSg,� <br />MAJOR MINOR <br />1 2 <br />—... e_ <br />3 4-- <br />- W_ <br />38 <br />5 6 <br />7 8 <br />40 <br />9 10 <br />11 12 <br />41 <br />13 14 <br />- <br />15 16 — <br />17 18 - <br />19 20 <br />44 <br />21 22 <br />23 24 — <br />25 26 <br />27 28 <br />29 30 <br />31 32 <br />33 <br />35 36 - <br />� 37 <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />M - <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />_ <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />145 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING48 <br />49 <br />............ _. _...... <br />FLAMMABLE VAPORS REMOVED <br />50- <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />_ <br />SAMPLING <br />53 <br />54 <br />- <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED <br />ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK CAVE) <br />FOLLOWS:�C- <br />MAJOR 57 MINOR 58 <br />NO 59 <br />VIOL. ❑ VIOL. ❑ <br />VIOL. <br />OFFICE: <br />INSP: <br />IRECEIVED BY: <br />�� �j r <br />TITLE: 5r, <br />/e- r <br />PHONE; BECK: <br />HUT -3 ORIGINAL <br />sirs <br />