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UNDERGROUnTANK PROGRAM OFFICIAL INS <br /> SAN JOAQUIN HEALTH DISTRIC TION REPORT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95206 <br /> PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS:/02-�' 'r- < CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YESN TANK TANK 02-- TANK TANK <br /> FORM A AND/OR B SUBMITTED?-(4t' COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> j� � PER # PER# PER # PER # <br /> �p/ytti 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 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 118 <br /> PIPING 19 120 <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 <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 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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 <br /> MAJOR 67 MINOR 58 Nd X59 <br /> VIOL ❑ VIOL. ❑ VIOL.LV <br /> OFFICE: INSP: /] RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> HUT-3 ORIGINAL 5/88 om <br />