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UNDERGROU�TANK PROGRAM OFFICIAL INSP TION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. q <br /> COUNTY NAME �\\// STOCKTON, CA 95205 / <br /> c�L7 PHONE NO. 468-3423 COUNTY #' / <br /> SITE NAME: iq,s INSPECTION DATE: <br /> SITE ADDRESS: Z-,'Oo W GD C[ CITY/STATE/ZIP L ,,4I <br /> CHANGES SITE/OWNER/PERMIT? YES N TANK TANK b v TANK Q7 TANK <br /> FORM A AND/OR B SUBMITTED? \ COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYP OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# PER# PER# <br /> Oz EXP.DATE- EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <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 1017 <br /> MONITORING SYSTEM 11 12 L� <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 120 <br /> INVENTORY RECONCILIATION 21 2 <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 W43 <br /> FLAMMABLE VAPORS REMOVED <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) �/ <br /> FOLLOWS <br /> MAJOR 57 MINOR X58 NO 59 <br /> VIOL. LJ VIOL. El VIOL❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: 19 CK: <br /> HUT-3 ORIGINAL 5/W 0� <br />