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UNDERGROU�TANK PROGRAM OFFICIAL INSP&TION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: Z , f � y „ INSPECTION DATE: �Q12 <br /> SITE ADDRESS: lUoj 2 r>� -(�. CITY/STATE/ZIP / ,/�� . <br /> CHANGES SITE/OWNER/PERMIT? YES N TANKTANK Z TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION S��COnMPUTER# PER # PER # PER # PER# <br /> �! EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONMN s <br /> MAJOR I MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 110 1 _ <br /> MONITORING SYSTEM 11 112 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 128 <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 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 155 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED A$ <br /> 13 <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO m59 <br /> VIOL LJVIOL. El VIOL P <br /> OFFICE: INSP�j RECEIVED BY: <br /> TITLER S, PHONE: PECK: <br /> HUT-3 ORIGINAL 5/88 O <br />