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UNDERGROUN._ ANK PROGRAM OFFICIAL INSPE•^TION REPORT <br />kN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME /n7 ,mv, / STOCKTON, CA 95205 COUNTY # <br />a... PHONE NO. 468-3423 <br />SITE NAME: <br />INSPECTION DATE: 6+/13 /67 <br />e <br />SITE ADDRESS:�,� <br />CITY/STATE/ZIP <br />5� k4,0.,v <br />SOS` <br />CHANGES SITE/OWNER/PERMIT? <br />N <br />TANK p I <br />TANK 02 <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />P <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />TYPE OF INSPECTION <br />SITE COMPUTE # <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />LANK CONR:N15MAJORPERMIT <br />TO OPERATE <br />1 <br />2CHANGE <br />IN CONDITIONS TO OPERATE <br />3 <br />4APPROVED <br />rEXP.E <br />CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />_ <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />_ <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />_ <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />132 <br />1_ <br />UNAUTHORIZED RELEASES REPORTED <br />3334 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W43 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />_ <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />_ <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 />� ��"" <br />SYSTEM STATUS (MUST MARK ONE) /(b (2f'0/OA;t6 <br />Ck <br />FOLLOWS: <br />Observes /"8jY7"Is or <br />SoOy q Qac -}i,,.k �j a <br />e4 7 xq a& 8T fj Pm g-tc <br />Gid <br />t G O r / a vk. <br />i.�;4" — <br />MAJOR 57 MINOR 58 NO <br />❑ ❑ <br />59 <br />❑ <br />S <br />k <br />VIOL. VIOL VIOL <br />(a5 <br />P.u! <br />.vE <br />m t... <br />OFFICE: <br />INSP�,55C // <br />RECEIVED BY: <br />TITLE: E S T <br />PHONE: <br />BECK <br />NUT -3 ORIGINAL eee GM <br />