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UNDERGROU►`TANK PROGRAM OFFICIAL INSPF^TION REPORT <br />SAN JOAQUIN HEALTH DISTRICI <br />1601 E. HAZELTON AVE. <br />/��STOCKTON,CA 95205 COUNTY <br />COUNTY NAME , f1 #3 9 <br />Z?,f -WC PHONE NO. 468-3423 <br />SITE NAME:v u <br />Wa/w <br />INSPECTION DATE: <br />/Q <br />� / <br />SITE ADDRESS: IO2 <br />CITY/STATE/ZIP S46tl •� <br />04 95Z03 <br />CHANGES SITE/OWNER/PERMIT? YES <br />(_N'W TANK OZ- <br />TANK p� TANK <br />ANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER COMPUTER <br />OMPUTER <br />NUMBER /)L <br />NUMBER / a NUMBER <br />NUMBER <br />TYrO�F�1.�jJ'SPECTION SITE COMPUTER # <br />PER # 1/ <br />PER # �,oe� PER # <br />PER # <br />n I I D S <br />1��" ' <br />EXP. DATE <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK TANK CONTENTS <br />MAJOR I MINOR <br />PERMIT TO OPERATE 1 <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE 3 <br />14 <br />APPROVED CONSTRUCTIONy-- <br />WRITTEN MONITORING PROCEDURES 7 <br />8 <br />APPROVED MONITORING SYSTEM 9 <br />10 <br />MONITORING SYSTEM 11 <br />12 <br />APPROVED MONITOR FREQUENCY 13 <br />14 <br />MONITORING RECORDS MAINTAINED 15! <br />I6 <br />ACCESS CASING SECURED 17 <br />18 _ <br />—_-_ —� <br />PIPING 19 <br />20 <br />INVENTORY RECONCILIATION 21 <br />122 1_ <br />TANK GAUGING 23 <br />24 <br />_ <br />APPROVED RESPONSE PLAN 25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE 27 <br />28 <br />SAMPLING 29 <br />30 <br />APPROVED TANK REPAIRS 31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED 33 <br />34 <br />_ <br />SAFETY HAZARD 35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOS <br />REMOVAL OF RESIDUAL 38 <br />39 <br />FLAMMABLE VAPORS RE VIED 40 <br />ACCESS LOCATIONS ALED41 <br />42 <br />POWER DISCON CTED <br />43 <br />OWNER/OP ToMONITORING 44 <br />145 <br />PERMANENT TANK C URE <br />REMOVAL OF RESIDUAL RIALS 46 <br />47 <br />_ <br />PIPING 48 <br />49 <br />_ _ <br />FLAMMABLE VA S REMOVED 50 <br />UNAUTHORI RELEASE 51 <br />52 <br />SAMPU 53 <br />54 <br />_ <br />IMPR PER ABANDONMENT 55 <br />56 <br />THE MARKED ITEMS REPRES�NT VIOJ.ATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: -4a <br />57 58 59 <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL VIOL VIOL <br />OFFICE: <br />INSP: <br />/b r <br />! <br />RFlCid Y: <br />TITLE: /�L f <br />PHONE: <br />RECK: <br />HUT -3 ORIGINAL 51W U" <br />