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UNDERGROUP` TANK PROGRAM OFFICIAL INSP"TION REPORT <br />r✓SAN JOAQUIN HEALTH DISTRICISoo <br />1601 E. HAZELTON AVE- <br />COUNTY <br />l <br />COUNTY NAME /� , rooaw,� PHONE 0. STOCKTNO. 468-3423 CA 95205 COONrY # V <br />1 \ <br />siea 0 <br />HUT -3 ORIGINAL M <br />SITE NAME: <br />sw-w <br />ar� o1 <br />Z 1 <br />INSPECTION DATE: �Z� <br />SITE ADDRESS: C✓� <br />JJ <br />/ ��� <br />CITY/STATE/ZIP 9� <br />CHANGES SITE/OWNER ERMIT? YES <br />NO <br />TANK , �/� <br />TANK <br />TANK <br />NK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUM ER <br />P # <br />NUMBER <br />PER # <br />T OF INSPECTI <br />TE COMPUTER # <br />)519 <br />EXP. DATE <br />EXP. DATE <br />P. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR 1 MINOR ., <br />PERMIT TO OPERATE <br />1 <br />12 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />14 <br />1_ <br />APPROVED CONSTRUCTION <br />5 <br />1 6 <br />1_ <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 />_ <br />MONITORING RECORDS MAINTAINED <br />15 <br />'16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />_ <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />s <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />_ <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 />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />UAL <br />REMOVAL!RE <br />FLAMMABS REMOVED <br />ACCESS SEALED <br />POWER DTED <br />OWNER/ <br />F4647 <br />ERTANK CLOSUR <br />REMOVALUAL MATERIALS <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESEN I <br />LATIOt�yS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />�j <br />57 58 <br />59 <br />MAJOR MINOR NO <br />❑ ElVIOL <br />VIOL VIOL <br />OFFICE: <br />INSP: <br />1 / <br />Url <br />RECEIVED BY: <br />TITLE: � <br />�1� <br />r <br />PHONE: <br />RECK: <br />siea 0 <br />HUT -3 ORIGINAL M <br />