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UNDERGROUN)' TANK PROGRAM OFFICIAL INSPpr'TION REPORT <br /> \.sAN JOAQUIN HEALTH DISTRICT N-./ <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 COUNTY # 3 <br /> COUNTY NAME PHONE NO. 468-3423 <br /> SITE NAME: J fs S � J� /4 J� C INSPECTION DATE: �(� <br /> SITE ADDRESS: b g /Si W �B (A CITY/STATE/ZIP S/�'V <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK Q TANK TAN/K TANK <br /> FORM AAND/OR B SUBMITTED? COMPU R f COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMGPUTTEER# PER# PER# PER# PER# <br /> O J EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK 1AJ CONTENTS <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 23 124 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 130 1 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> 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 CO ECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) F LOWS: J J <br /> Q <br /> 58 MAJOR 57 MINOR NO 9 <br /> VIOL ❑ VIOL ❑ VIOL <br /> OFFICE: IN P: !N RECEIVED BY: <br /> TITLE:/PS ' PHONE: BECK: <br /> HUT-3 ORIGINAL siee O- <br />