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UNDERGROUP-1 TANK PROGRAM OFFICIAL INSPv 'TION REPORT <br /> -SAN JOAOUIN HEALTH DISTRICT•_ <br /> 1 1601 E. HAZELTON AVE. <br /> COOKY NAME J CYI4 J Q(.L STOCKTON, CA 95205 <br /> PHONE NO. 468-3423 COUNTY # 3 q p <br /> SITE NAME: 1H S'fz 6.1 � INSPECTION DATE: 3-5- `� <br /> SITE ADDRESS: 0 CITY/STATE/ZIP j. <br /> ,S'IvorxeA` C/¢ <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK O TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> r 4u A. Ax- a a � * EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONMN1s <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 23 124 <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 1 139 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 r45 <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING 44 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 _ <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK SOgNE)� FOLLOWS: � g2aLaei D— <br /> MAJO <br /> MINORry NO <br /> VIOL. VIOLEJ VIOLEI <br /> OFFICE: INSP• RECEIVED BY: <br /> ✓7 <br /> TITLE: 1� E c PHONE: RECK: <br /> HUT-3 ... 5/W Om <br />