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UNDERGROI LND TANK PROGRAM OFFICIAL INSVIECTION REPORT <br /> SAN JOAQUIN HEALTH DISTRK, <br /> 1601 E. HAZELTON AVE. COUNTY # <br /> STOCKTON, CA 95205 <br /> COUNTY NAME PHONE NO. 468-3423 <br /> SITE NAME: p !NUMBER <br /> TION DATE: �y <br /> /� . ✓1 �(hC ft t '�s <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER R COMPUTER <br /> NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# <br /> „jiryL_ EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR -.., "' II' '. -•. <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 19 120 <br /> INVENTORY RECONCILIATION 21 122 <br /> TANK GAUGING 23 124 <br /> APPROVED RESPONSE PLAN 25 126 1 _ <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 1 _ <br /> SAMPLING 29 30 .. <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 _ <br /> SAFETY HAZARD 35 36 _ <br /> CONDITIONS ABATED 737 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40ME <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED ME <br /> 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE i <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 /> 7 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEMSTATUS(MUST MARK ONE) 91 Sat �l <br /> FOLLOWS: Z" e.� r«_4.�C � Ceu=i � 1. "w <br /> MAJOR 57 58 <br /> MINOR NO 4— u u <br /> VIOL ❑ VIOL. ❑ VIOL ..p �. <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> HUT-3 ORIGINAL siee O- <br />