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UNDERGROUMTANK PROGRAM OFFICIAL INSP TION REPORT <br /> 'qPSAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 <br /> PHONE NO. 468-3423 COUNTY# JI <br /> SITE NAME: i l�J INSPECTION DATE: y� q <br /> SITE ADDRESS: ��%l l� CITY/STATE/ZIP Z,4,&r O <br /> CHANGES SITE/OWNER/PERMIT? YES t5P TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER DI COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTIONSITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> F'T PER # PER# PER # PER <br /> 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 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 122 <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 W44457 <br /> FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <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 T. <br /> SAMPLING 53 54 --T-� <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS T <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOW3r �- <br /> MAJOR 57 MINOR 58 NO 59 ` <br /> VIOL. ❑ VIOL. ❑ VIOL.YJ <br /> OFFICE: INSP: RECEIVED BY: <br /> zr-74 <br /> TITLE: PHONE: RECK: <br /> HUT-3 ORIGINAL seas ©M <br />