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Y <br /> UNDERGROUNANK PROGRAM OFFICIAL INSP ION REPORT �! 0 L� <br /> WAN JOAQUIN HEALTH DISTRICT e i <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 Q <br /> PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: ))7 /2 L Vp CITY/STATE/ZIP ' �s��� <br /> CHANGES SITE/OWNER/PERMIT? YES NO T NK TANK Z TANK TANK <br /> FORM A AND/ORB SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER/0p00 NUMBER 040 NUMBER NUMBER <br /> ( q / PER# ! ,/ .(j f7' PER# PER# PER# <br /> �d -0 J v EXP D7 Y5 EXP DATE C EXP DATE EXP DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> -__. -__--.. <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 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 W4445 <br /> � <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 148 149 _. _. __... _..._. _. . <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 51 52 � <br /> SAMPLING <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) <br /> FOLLOWS: <br /> 57 58 <br /> MAJOR MINOR NO 59 <br /> VIOL. VIOL VIOL 127-11 f <br /> OFFICE: INSP:/ RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> HUT-3 ORIGINAL siea ©M <br />