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UNDERGROU' 7j TANK PROGRAM OFFICIAL INSP ,TION REPORT <br />SAN JOAQUIN HEALTH DISTRIC'� <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 cQulfTr # <br />PHONE NO. 468-3423 <br />SITE NAME: PlS� h S��l <br />INSPECTION DATE: 30 90 <br />SITE ADDRESS: /fyys <br />� <br />CITY/STATE/ZIP <br />31i�44"w <br />N <br />n <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO <br />TANW <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />PER # iAbi "dad <br />NUMBER <br />PER # 03 <br />NUMBER <br />PER # /7b'S'O / <br />NUMBER <br />PER # /7aS-(� <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />q <br />7 ,lac www yh,v <br />�� p <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONN <br />MORAJMINOROR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />RECORDS MAINTAINED <br />13 <br />15 <br />14 <br />16 <br />MONITORING <br />ACCESS CASING SECURED <br />18 <br />_ <br />PIPING <br />19 <br />P <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />"�I' <br />L <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />9 <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W4445 <br />2 <br />POWER DISCONNECTED <br />3 <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50mm <br />7 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />t; hi ('We '-e' t" <br />r 44LIrZC.rk <br />42 o <br />M AJOR 57 MINOR NO <br />Li❑ <br />59.3 <br />VIOL. VIOL VIOL. <br />OFFICE: <br />INSP: <br />©Z.. <br />RECEIVED BY: <br />TITLE: <br />PHONE: <br />PHONE: <br />RECK: <br />y68 3165 <br />HUT -3 ORIGINAL sibs O, <br />