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UNDERGROUlf TANK PROGRAM OFFICIAL INSP TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC* <br /> (� D 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 <br /> PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: � INSPECTION DATE: <br /> SITE ADDRESS: f aids a CITY/STATE/ZIP S�o C <br /> CHANGES SITE/OWNER/PERMIT? YES N TANK jWS TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER 3 -e� TANK <br /> NUMBER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER <br /> PER# PER# PER# <br /> - PER# <br /> EXP.DATE <br /> 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 g 350 <br /> 7 _. Q 3� <br /> APPROVED MONITORING SYSTEM 9 10 0�D✓ CIiC- <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 e <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 p _ <br /> PIPING 19 20 _ U 62 <br /> INVENTORY RECONCILIATION 21 22 <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 /> -"-" - <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 <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 ONEI ,ly <br /> FOLLOWS: +T <br /> MAJO 57 58 qa et <br /> NO <br /> VIOL. ❑ VIOLR ❑ VIOL:❑ <br /> OFFICE: INSP: <br /> CL <br /> TITLE: (�� � � PRo 3 <br />'.HUT-3 <br /> ORIGINAL <br /> siee O� <br />