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UNDERGROW TANK PROGRAM OFFICIAL INWION REPORT <br /> SAN JOAQUIN HEALTH DISTRI <br /> 1641 E. HAZELTON AVE. <br /> COUNTY NAME - STOCKTON, CA 95245 COUNTY #,l� <br /> PHONE NO. 468-3423 <br /> SITE NAME: j INSPECTION DATE: fr <br /> SITE ADDRESS: T CITY/STATE/ZIP <br /> (�r'c� �, <br /> , c` . ' <br /> CHANGES SITE/OWNER/PERMIT? YES TANK ) TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? S COMPUTER 1 COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYP OF INSPECTION SITfE'C%OMP ER# PER# PER# PER# PER <br /> I / f # <br /> EXP.DATE 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 24 <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 3'7 <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 r46147 <br /> PIPING 49 <br /> FLAMMABLE VAPORS REMOVED UNAUTHORIZED RELEASE 52SAMPLING 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 58 NO 59 <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> , <br /> PHONE: CK: <br /> TITLE: <br /> HUT-3 ORIGINAL $� OM <br />