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UNDERGROU TANK PROGRAM OFFICIAL INSP ION REPORT <br /> WAN JOAQUIN HEALTH DISTRICT <br /> 1601 E HAZELTON AVE- <br /> COUNTY NAME STOCKTON, CA 95205 <br /> PHONE NO. 468-3423 COUNTY # 3q <br /> SITE NAME: <br /> 7,PAc 0� INSPECTION DATE: <br /> SITE ADDRESS: <br /> 5717 / <br /> 7 l / ��� C �L(�/�CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PIERMIT. YES NO T NK / TANK Z TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTE COMPUTE COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> y �� PER # PER# PER# PER# <br /> /W •�/ I EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANKCONMN� <br /> MA OR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 -`---'-'-- -APPROVEDCONSTRUCTION5 6 -- - ---- <br /> WRITTEN MONITORING PROCEDURES 7 8 - <br /> APPROVED MONITORING SYSTEM g 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 <br /> INVENTORY RECONCILIATION 21 2 "- <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 REPORTED33 34 <br /> SAFETYHAZARD <br /> 35 36 <br /> CONDITIONS ABATED 37 -- <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 :55177--- <br /> PIPING <br /> FLAMMABLE VAPORS REMOVED - --- - <br /> UNAUTHORIZED RELEASE <br /> SAMPLING --- <br /> IMPROPER ABANDONMENT .. " <br /> SYSTEM STATUS(MUST MARK ONE) <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> FOLLOWS. Z G <br /> MAJOR 57 MINOR ❑ <br /> 58 NO 59 <br /> VIOL. VIOL. VIOL❑ <br /> OFFICE: INSP:�/ RECEIVED Y: <br /> TITLE: Z511S PHON R <br /> HUT-3 ORIGINAL 5/88 OM <br />