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UNDERGROI 7) TANK PROGRAM OFFICIAL INS -nON REPORT <br /> �- SAN JOAQUIN HEALTH DISTRICT% <br /> COUNTY NAME <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 <br /> PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: p7F <br /> /L T INSPECTION DATE:�Ca <br /> SITE ADDRESS: 73 Y3114 <br /> 3 /V4, /STATE/ZIP s� <br /> CHANGES SITE/OWNER/PERMIT? YES NOTANK nn // TANK Q TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPtal COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBERNUMBERp NUMBER NUMBER NUMBER <br /> PER# �ec.3 ( PER# a.�Q PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TAN TANK -0rrterrrs <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 7- <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 RECONCIUATION 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 35 36 <br /> CONDITIONS ABATED 37 <br /> 71- <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 ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTTD AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:No ' <br /> 57 58 59 <br /> OL.- LJVIOLL..R ❑ VIOL.11 �- <br /> OFFICE: INSP: l0 RECEIVED BY: <br /> ��-�C/�J <br /> Ol <br /> TITLE: PHONE: BECK: <br /> HUT-3 ORIGI AL 51W O� <br />