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UNDERGROlp TANK PROGRAM OFFICIAL INS CTION REPORT <br /> SAN JOAQUIN HEALTH DISTRIW <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: n yy INSPECTION DATE: <br /> W1a��aCJ�O Drm�e <br /> SITE ADDRESS: I..o � CITY/STATE/ZIP <br /> vt� _ <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK m I TANK TANK n c TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# PER# PER# <br /> �. <br /> Ac. <br /> b I G EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS �1 <br /> MAJOR MINOR COO .fte <br /> PERMIT TO OPERATE 1 2 r <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 -- <br /> APPROVED MONITORING SYSTEM 9 1o_ <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> �.. <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 "- <br /> f - - _ .-------- <br /> INVENTORY RECONCILIATION 21 22 . <br /> ,/ " <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 /> _. <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL R4445 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> 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 /> —_. <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 , MINOR 0 <br /> NO 59 <br /> VIOL. L�JX VIOL. VIOL.OL. <br /> OFFICE:. INSP: RECEIVED BY: <br /> TITLE: C PHONE: RECK: + <br /> HUT-3 ORIGINAL Slee O <br />