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r � <br />COUNTY NAME <br />SITE NAME: <br />UNDERGROUJITANK PROGRAM OFFICIAL INSPTION REPORT <br />SAN JOAQUIN HEALTH DISTRIC <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />INSPECTION DATE: <br />SITE ADDRESS: <br />/5 A3 -7 <br />CHANGES SITE/OWNER/PERMIT <br />FORM A AND/OR B SuBMITTED? <br />TYPE OF INSPECTION I SITE CO <br />OPERATIONAL TANK <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURREN( <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />CITY/STATE/ZIP <br />SLr�r_.ir_ C', _ , �o <br />? YES NO <br />TANK <br />COMPUTER C <br />NUMBER <br />PER # �� <br />EXP. DATE <br />" <br />TANK <br />COMPUTER <br />NUMBER <br />PER # )a <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # �3� S� <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # j 21a� `� <br />EXP. -DATE <br />_L-1 <br />MPUTER # <br />TANK CONTENTS <br />MAJOR I MITdOR <br />;E <br />1 2 <br />_ <br />40 <br />41 42 <br />3 4 <br />5 6 <br />- <br />7 8 <br />9 110 <br />11 12 <br />13 14 <br />15 16 <br />17 18 <br />19 20 <br />21 22 <br />23 24 <br />25 26 <br />27 28 <br />29 30 <br />31 32__ <br />33 34 <br />F �_ <br />35 36 <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />SYSTEM STATUS (MAST MARK ONE) <br />•rte%/ <br />�m <br />57 58 59 <br />MAJOR NO <br />VIOL. ❑ VIOL..R ❑ VOL. ❑ <br />OFFICE <br />HUT -3 <br />7A I ,T le <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />rs <br />FOLLOWS- /fU/ !C /Y�t37JZZ al /I C-t0IU)Gcf refl3 e <br />A,,'!&_1lir�sh/�r l.�fJi.. iIfSF7 I? Li..J^c �[T1-i71 - <br />INSP. __ �, tV f Q� <br />TITLE: <br />ORIGINAL <br />RECEIVED BY: <br />PHONE: <br />RECK: <br />5/8R 0 m <br />38 3s <br />_ <br />— <br />40 <br />41 42 <br />44 45 <br />•rte%/ <br />�m <br />57 58 59 <br />MAJOR NO <br />VIOL. ❑ VIOL..R ❑ VOL. ❑ <br />OFFICE <br />HUT -3 <br />7A I ,T le <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />rs <br />FOLLOWS- /fU/ !C /Y�t37JZZ al /I C-t0IU)Gcf refl3 e <br />A,,'!&_1lir�sh/�r l.�fJi.. iIfSF7 I? Li..J^c �[T1-i71 - <br />INSP. __ �, tV f Q� <br />TITLE: <br />ORIGINAL <br />RECEIVED BY: <br />PHONE: <br />RECK: <br />5/8R 0 m <br />