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UNDERGROU► TANK PROGRAM OFFICIAL INSP/ TION REPORT <br />' .� AN JOAQUIN HEALTH DISTRICT.,i <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 <br />DHOI nllury �f <br />%.0 �. <br />SITE NAME: L <br />INSPECTION DATE: <br />L��wY <br />SITE ADDRESS: <br />CITY/STATE/ZIP <br />CHANGES SITE/OWNER/PERMIT? <br />YES NO TANK di* <br />TANK TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTEIT <br />COMPUTER COMPUTER <br />COMPUTER <br />TYPE O SPECTION SITE COMPUTER # NUMBERL <br />U <br />NUMBER NUMBER <br />NUMBER <br />PER # <br />2S (7 <br />PER # PER # <br />PER # <br />EXP. DATE <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />OPERATION L TANK <br />mNK CONTENT S PC <br />MINOR <br />— <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />MONITORING SYSTEM <br />11 112 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 116 <br />ACCESS CASING SECURED <br />17 118 <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 —.__.....__._.. <br />30 <br />APPROVED TANK REPAIRS <br />31 32 µ <br />UNAUTHORIZED RELEASES REPORTED <br />—�..__._.. <br />33 34 <br />-_.______. <br />--------- <br />SAFETY HAZARD <br />35 36 <br />_.. .. <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />----— --- - <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W4445 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />-- <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS46 <br />47-- <br />PIPING <br />48 49 <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />51 52 <br />SAMPLING <br />53 54 <br />IMPROPER ABANDONMENT <br />55 56 <br />THE MARKED ITEM EPRESENT IOtLATIONS AND MUST B5 CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />: <br />FOLLOWS57 <br />58 <br />3 <br />59 <br />MAJOR MINOR NO <br />VIOL. <br />VIOL. VIOL <br />S <br />OFFICE <br />4 <br />INSP: <br />"/ / e � y l <br />�+rw <br />RECE <br />BY: <br />TITLE/:Sr.(�' <br />PHONE <br />BECK: <br />'u' 3 ORIGINAL <br />siae O <br />