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UNDERGROUP9 <br />COUNTY NAME oSair Tom d�..:, <br />TANK PROGRAM OFFICIAL INSPr ^.TION REPORT <br />SAN JOAQUIN HEALTH DISTRICT" <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 COUNTY # ? O <br />PHONE NO 168_3423 <br />HUT -3 ORIGINAL 5/88 O, <br />SITE NAME: <br />a/ <br />rtt O <br />INSPECTION DATE: <br />v <br />SITE ADDRESS: <br />CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? <br />YES TANK <br />TANK TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />✓ COMPUTER <br />COMPUTER COMPUTER COMPUTER <br />TYPE OF INSPECTION SITE COMPUTER # NUMBER <br />NUMBER NUMBER NUMBER <br />PER # <br />PER # PER # PER # <br />EXP. DATE <br />EXP. DATE EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />�KCON NTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />-- <br />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />11 12APPROVED <br />MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />_ <br />23 24 <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />129 130 <br />APPROVED TANK REPAIRS <br />131 132 <br />UNAUTHORIZED RELEASES REPORTED <br />133 134 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE' <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W44459 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />(PING <br />48 49 <br />/p�7C� <br />/J/GS'I/i r_i/70irli-•� <br />/ ^'w <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />53 54 <br />IMPROPER ABANDONMENT <br />55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOW <br />MAJOR 57 MINOR 58 NO <br />59 <br />VIOL. ❑ ❑ <br />VIOL VIOL <br />OFFICE: <br />INSP: <br />RECEIVED BY: <br />0 <br />C�GtI�CJI CJL <br />TITLE: C N, <br />PHONE: <br />BECK: <br />HUT -3 ORIGINAL 5/88 O, <br />