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UNDERGROUNI) TANK PROGRAM OFFICIAL INSPF^TION REPORT <br /> �'PAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: 1D-23-!3 <br /> SITE ADDRESS: `J /fZ �f'T CITY/STATE/ (�yg- 9 3 7 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TAN TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> 1y' y�� PER # �� PER# PER# PER # <br /> I� W EXP D E EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CON IM <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 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 I 38 139 <br /> FLAMMABLE VAPORS REMOVED W43 <br /> ACCESS LOCATIONS SEALED 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 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> /C <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL ❑ VIOL ❑ VIOL <br /> OFFICE: INSP: RECEIVED BY: <br /> L [ff70 7q, 0 > TITLE: PHONE: BECK: <br /> NUT-3 J G ORIGINAL a" <br />