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UNDERGROUN^ TANK PROGRAM OFFICIAL INSPErTION REPORT <br /> ,.,3AN JOAOLHN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. `! <br /> COUNTY NAME STOCKTON, CA PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: //`per Lv F INSPECTION DATE: <br /> SITE ADDRESS: y�Z �4/R/ CITY/STATE/ZIP 4q <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK7Qo8- 1 TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER / COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER4tRjt 47 NUMBER NUMBER NUMBER <br /> /�"AIR/"AO PER# PER# PER # PER# <br /> OPERATIONAL TANK mNK coNreNrs J— EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> O <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 /> _. <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 4 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED 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 REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 119AZ4 als � f= i u S !G'�ros(, <br /> ♦� "I <br /> Lo B <br /> MAJOR 57 MINOR 8 NO 59 <br /> VIOL ❑ VIOL ❑ VIOL <br /> OFFICE: INSP: � RECEIVED BY: <br /> TITLE: PONE: RECK: <br /> HUT-3 ORIGINAL Sias 0M <br />