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UNDERGROUN- TANK PROGRAM OFFICIAL INSPLl`ION REPORT <br /> -oAN JOAQUIN HEALTH DISTRICT - <br /> \ 1601 E. HAZELTON AVE. n <br /> COW NAME `� IJ PHONE NO. 468-3423 <br /> STOCKTON, CA 205 COUNTY # 3_I <br /> SITE NAME: T j <br /> U S SP INSPECTION DATE: J ( 15I <br /> n-f- <br /> SITE ADDRESS: U855 U3 . �C�� �r' � a CITY/STATE/ZIP ST L,-', g 5 a Q <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK OOC I TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> l IOSUY I EXP.DATE EXP.DATE EXP.DATE EXP DATE <br /> OPERATIONAL TANK TANKCONTENlS <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 9 110 1 <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 /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 _ <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 _ <br /> POWER DISCONNECTED mm <br /> 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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 1� �� <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: Ill �C��� 9 Sttb <br /> MAJOR 57 MINOR 58 59 <br /> NO <br /> VIOL. ❑ VIOL ❑ VIOL .(-� <br /> OFFICE: INSP• RECEIVED BY: <br /> C. LJc�^ n � <br /> TITLE: PHONE: RECK: <br /> HUT-3 ORIGINAL 5/88 ©• <br />