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UNDERGROUND TANK PROGRAM OFFICIAL INSPE"ION REPORT <br /> ,,,..AN JOAOUIN HEAQLNTH DISTRICT1601 E. HAZj Q <br /> COUNTY NAME PHONE NO. 468-3423 STOCKTON, CA 95205 <br /> COUNTY # <br /> SITE NAME: EE g LM O INSPECTION DATE j�_g <br /> SITE ADDRESS: I n /�T� �d CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO VTANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER ' COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER # <br /> /ih V V '—' EXP.DATE- EXP.DATE EXP.DATE P.DATE <br /> ENTS <br /> OPERATIONAL TANK TANK MAJOR <br /> 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 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 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 _ <br /> ACCESS LOCATIONS SEALED 4142 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS V5556 <br /> 47 <br /> PIPING 49 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 52 <br /> SAMPLING 54 <br /> IMPROPER ABANDONMENT <br /> THE MARKED TEEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: e—lop O <br /> 57 58 9 <br /> MAJOR <br /> MINOR NO <br /> VIOL. LJVIOL. ❑ VIOL. <br /> /3e /Lf0002d✓' <br /> OFFICE: INSP: IV RECEIVED BY: <br /> TITLE: °j PHONE: RECK: <br /> HUT-3 , •ORIGINAL sig O' <br />