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UNDERGRO' AP TANK PROGRAM OFFICIAL INS' :r'TION REPORT <br /> '- <br /> AN JOAQUIN HEALTH DISTRIC_ _ <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: 7161 L3 <br /> S <br /> SITE ADDRESS: CITY/STATE/ZIP i <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR 6 SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> // 4- PER# PER# PER# PER# <br /> G41 7 L R (e EXP DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK LINK CONIEWIS <br /> MAJOR MINOR ,.. <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 56 <br /> WRITTEN MONITORING PROCEDURES 7 t14 <br /> APPROVED MONITORING SYSTEM 9 / <br /> MONITORING SYSTEM 11 ✓ <br /> APPROVED MONITOR FREQUENCY 13 <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 r45 <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING 44 <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: 7k/ <br /> MAJOR57 MINOR 58 NO 59 <br /> VI <br /> VIOL OL ❑ VIOL❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> SEN;or,I iffeS EDN%riE NT9H"EAL" ,..,a t BECK: <br /> HUT-3 ORIGINAL 5/W 0' <br />