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UNDERGROU►'^ TANK PROGRAM OFFICIAL INSPr'TION REPORT <br />„SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />couxrr NAME STOCKTON,CA 935205 423 COUNTY #3 <br />Lmjy'L. V L3\, <br />PHONE NO. 468- <br />34-- Q <br />O/ <br /># <br />INSPECTION DATE: <br />SITE NAME: &ls/ �V <br />/ <br />SITE ADDRESS: <br />Q CITY/STATE/ZIPS'-j< yM <br />CA 9�� <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO TANK p J <br />TANK O ]- TANK O <br />TANK <br />FORM AAND/ORB SUBMITTED? <br />COMPUTER <br />COMPUTER COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />NUMBER <br />NUMBER <br />TYPE SITE COMPUTER # <br />INSPECTION N�� <br />PER # <br />PER # PER # <br />PER # <br />SOF <br />w <br />r e'(� 1 { la..�[�, /VIS <br />EXP. DATE <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONMUM <br />LL <br />MAJOR <br />MINOR <br />PERMIT TO OPERATE <br />1 <br />2 _ <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 _ <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />/2 _ <br />APPROVED MONITOR FREQUENCY <br />13 <br />114 1_ <br />MONITORING RECORDS MAINTAINED <br />15 <br />116 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPUNG <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />_ <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 _ <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />low <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />a <br />57 <br />7MINOR 58 <br />MAJOR NO <br />❑ ❑ <br />X55999 <br />VIOL VIOL VIOL <br />LJ <br />OFFICE: <br />INSP: <br />ix -J <br />RECEI BY: <br />} <br />TITLE: <br />y- jl <br />PHONE: <br />RECK: <br />HUT -3 ORIGINAL 5/m O"" <br />