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UNDERGROUTANK PROGRAM OFFICIAL INSTION REPORT <br /> WAN JOAQUIN HEALTH DISTRICP <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: ' INSPECTION DATE: 3-/0- i3 <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> s v� <br /> CHANGES SITE/OWNER/PERMIT? YES :N:O TANK TANK 2 TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER ' COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYP OF INSPECTION SITE CCOMPUTERR# PER# PER# PER# PER# <br /> f(l� -( o -7V EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANKCONTENTS <br /> MAJORRMINOR <br /> Dloo <br /> QQ� <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 19 120 <br /> INVENTORY RECONCILIATION 21 122 <br /> TANK GAUGING 23 124 <br /> APPROVED RESPONSE PLAN 25 126 s <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 128 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED P, 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 139 —_ <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED W77 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 147 <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 ONF) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 �( e <br /> VIOL. VIOL. ❑ VIOL.❑ / <br /> OFFICE: INSP <br /> -. / RECEIVED BY: <br /> Y/-vi <br /> Z), 1�445-zI, <br /> TITLE: P N BECK: <br /> HUT-3 ORIGINAL seas a <br />