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} UNDERGROUAANK PROGRAM OFFICIAL INSPE&ON REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 5205 <br /> COUNTY NAME © PHONE NO. 468-93423 COUNTY # <br /> SITE NAME: 'i INSPECTION DATE: q <br /> SITE ADDRESS:I orto0`60 141 CITY/STATE/ZIP co <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK ) 7NUMBER <br /> TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # PER# PER# <br /> [. I �•Q 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 22 _ <br /> TANK GAUGING 23 24 _. <br /> APPROVED RESPONSE PLAN [3L7 <br /> _ <br /> UNAUTHORIZED RELEASE OCCURRENCE <br /> SAMPLING APPROVED TANK REPAIRS UNAUTHORIZED RELEASES REPORTED SAFETY HAZARD CONDITIONS ABATED <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 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 56 59 <br /> NO <br /> VIOL. ❑ VIOL ❑ VIOL l <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE:CNU/AWN PHONE: BECK: <br /> (D- <br /> HUT-3 ORIGINAL sise <br />