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UNDERGROUND TANK PROGRAM OFFICIAL INSPFrTION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMESTOCKTON, CA 95205 COUNTY # 3'? <br /> Sq. J�� G1IrJ PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br /> N <br /> .ay 14k <br /> SITE ADDRESS: O F rA2 <br /> CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? E N TANK / TANK TAN 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 /> /(�j Z EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK coNreNn <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 K2526 <br /> INVENTORY RECONCILIATION <br /> TANK GAUGING <br /> APPROVED RESPONSE PLAN UNAUTHORIZED RELEASE OCCURRENCE SAMPLING APPROVED TANK REPAIRS UNAUTHORIZED RELEASES REPORTED SAFETY HAZARD CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 4142 <br /> POWER DISCONNECTED 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 <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAJVIOLOR ❑ VIOLL..R ❑ VIOL.LrJ <br /> OFFICE: INSP. RECEIVED BY: <br /> TITLE: n�us PHONE: RECK: <br /> HUT-3 /'C ORIGINAL 5/m 0M <br />