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UNDERGROUF 'ANK PROGRAM OFFICIAL INSPE <br />,,.N JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 <br />f.AIINTY NAME PHONE NO ARR_RA9R <br />'ON REPORT <br />u COUNTY # 517 <br />SITE NAME: <br />/ L ' <br />6 v2525�' INSPECTION DATE: <br />SITE ADDRESS: <br />9 5e h „ /�,5- <br />✓e CITY/STATE/ZIPS C.Oc <br />cyzp <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO <br />TANK /L <br />NK <br />TANK <br />TANK <br />COMPUTER <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />OMPUTER <br />COMPUTER <br />NIRA BERIO no <br />NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF IN PECTION SITE COMPUTE <br /># <br />PER #V(, <br />PER # <br />PER # <br />PER # <br />EXP. DA <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TARKCONTENB <br />MAJOR MINOR <br />- <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />120 <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />23 <br />124 <br />1 <br />APPROVED RESPONSE PLAN <br />25 <br />126 <br />1 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />_ <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />_ <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />145 <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 />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 CORRE ED <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 59 <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL. VIOL VIOL <br />OFFICE: <br />INSP: <br />RECEIVED BY* <br />TITLE: <br />(A lf4 <br />PHONE: <br />HECK: <br />HUT-3 ORIGINAL 5/88 0- <br />