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UNDERGR fND TANK PROGRAM OFFICIAL I ECTION REPORT <br /> SAN JOAQUIN HEALTH DISTRIW <br /> COUNTY NAME 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 <br /> SITE NAME: PHONE NO. 468-3423 COUNTY # <br /> INSPECTION DATE: <br /> SITE ADDRESS: -� <br /> �c3 X00 LOuiaG "qe CITY/STATE/ZIP <br /> CHANGES SITE YES NO TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER TANK TANK TANK <br /> TYPE OF INSPECTION NUMBER COMPUTER COMPUTER COMPUTER <br /> _ SITE COMPUTER# NUMBER NUMBER NUMBER <br /> PER# C/O//o -[2/ PER# 1{(i/,6-G2. PER# <br /> EXP.DATE PER# <br /> OPERATIONAL TANK EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS <br /> PERMIT TO OPERATE MAJOR MINOR <br /> 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 MAINTAINED15C <br /> ACCESS CASING SECURED 17 18 -- - <br /> 16 <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 40 - .. <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED -------- —"- <br /> OWNER/OPERATOR MONITORING43 <br /> qq 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS q6 47 <br /> PIPING 48 49 --- <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 51 52 --- <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> SYSTEM STATUS(MUST MARK ONE THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> FOLLOWS: <br /> MAJOR MINOR NO 59 <br /> VIOL. VIOL. VIOL❑ <br /> OFFICE: INSP: <br /> RECEIVED BY: <br /> TITLE: PHONE: CK: <br /> 1UT-3 <br /> ORIGINAL <br /> 5/88 ©m <br />