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UNDERGROL' ) TANK PROGRAM OFFICIAL INSi ;TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME. STOCKTON, CA 95205 CUONTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: �n�e51,w- _ INSPECTION DATE:$' <br /> SITE ADDRESS: SG31�.3/1/a�t�uhbu� fsf c1jCy`�ITY/STATE/ZIP �� �� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK p T TANK 0 TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION,.'0 SITE CO1J MPU2QEXP.DATE <br /> NUMBPER#ER NUMBER NUMBER NUMBER <br /> PER# PER <br /> �DA <br /> bl;1 / a a3 9 EXP.DATE EXP.DATE <br /> OPERATIONAL TANK IMK UUNME <br /> MAJOR I 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 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 444r <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <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 CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 6D anO� <br /> 57 58 59 <br /> VIOL R ❑ MINVIOLOR ❑ No <br /> VIOL❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: 4vl HONE: RECK: <br /> HUT-3 ORIGIt`IAL 5/w ©M <br />