Laserfiche WebLink
UNDERGROUNh TANK PROGRAM OFFICIAL INSPr^.TION REPORT <br />SAN JOAQUIN HEALTH DISTRICI <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 COUNTY # <br />u .. I <br />SITE NAME: 04G� <br />�v�'% <br />INSPECTION DATE: / /y- <br />J`3 <br />SITE ADDRESS: <br />CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? <br />YES NO <br />TANK <br />TANK <br />TANK TANK <br />L/ - <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER COMPUTER <br />NUMBER NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION SITE COMPUTER <br /># <br />PER # <br />PER # <br />PER # PER # <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />NM <br />IANIOR <br />f SC% f <br />5{�U 5U0 <br />MI R <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 />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />11 12 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />- <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />_ <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />It <br />APPROVED RESPONSE PLAN <br />25 26 <br />_ <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />I <br />SAMPLING <br />29 30 <br />_ <br />APPROVED TANK REPAIRS <br />31 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />_ <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 142 <br />1.__ <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 145 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />53 54 <br />IMPROPER ABANDONMENT <br />65 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS IMUST MARK ONE) <br />FOLLOWS: <br />57 58 59 <br />MAJVIOL El VIOL El VIOL <br />MINOR NO ❑ <br />INSL/ <br />TITLE: <br />RECEIVED BY: <br />PHONE: <br />HUT -3 ORIGINAL 5/88 <br />