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UNDERGROUN" TANK PROGRAM OFFICIAL INSPF^TION REPORT <br /> `6AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 <br /> PHONE NO. 468-3423 <br /> SITE NAME: / A-t47V Sb� p INSPECTION DATE: <br /> SITE ADDRESS: s BS�Q (���/ CITY/STATE/ZIP C,� - 9J Zp <br /> CHANGES SITE/OWNER/PERMIT? YES NO TAPQK ) ^' TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTE COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> �Z / PER# PER# PER# PER# <br /> EXP.DATE- EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJORI 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 ' <br /> 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED TEEMS REPRESE;WVIOLATIONS AND MUST BE CORRECTED AS , <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 1 <br /> MAJOR 57 MINOR VIO58 NO 59 <br /> VIOL LJ 'M' ❑ VIOL ler `L <br /> OFFICE: INSP: CA) RECEIVED BY: <br /> TITLE: gs PHONE: BECK: <br /> HUT-3 ORIGINAL siva ©, <br />