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UNDERGROUTANK PROGRAM OFFICIAL INSP TION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 <br /> COUNTY NAME &" Q J-® L� PHONE NNO. 468-3423 COUNTY # 3q <br /> SITE NAME: 8a4slc `lp� JINSPECTION DATE: <br /> SITE ADDRESS: d 3 �� Sayl �a �� CITY/STATE/ZIP V{/5 bus� 6/9 f� � 534,-7 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK p TANK D TANK <br /> R <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTECOMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF,!INSPECTION <br /> SITE COMPUTER# PER# PER# PER# PER# <br /> r4% W ✓w I '�t Z�/.;L- EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK WNK 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 22 <br /> TANK GAUGING 23 124 <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 38 r43 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING 44 <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 /> 59 <br /> MAJOR MINOR <br /> 57 NO <br /> VIOL. VIOL. VIOL LJ <br /> OFFICE: INSP.Xe <br /> RECEIVED BY: <br /> TITLE: I.J <? PHONE: PECK: <br /> HUT-3 ORIGINAL 5/88 ©M <br />