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UNDERGROUI ' TANK PROGRAM OFFICIAL INSP' ,TION REPORT <br /> ti-.SAN JOAQUIN HEALTH DISTRICT _ <br /> 1601 E. HAZELTON AVE. � <br /> STOCKTON, CA 95205 COUNTY #5 <br /> COUNTY NAME PHONE NO. 468-3423 <br /> SITE NAME: mt 4 �/U INSPECTION DATE: /Q// <br /> SITE ADDRESS: �ry���(�y CITY/STATE/ZIP t/ r� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER61 COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # PER # PER # PER# <br /> EXF'. DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK —MA—AOR <br /> A—AOMINNOROR Nn ; <br /> R <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 U43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50mm <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPUNG 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST PT CORRECTED AS— <br /> SYSTEM STATUS(MUST MARK ONE) g FOLLOWS: �� <br /> 57 58 <br /> MAJOR MINOR NO 5ry <br /> VIOL VIOL VIOL 11� <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE�LEQ` S„ PHONE: BECK: <br /> HUT-3 ORIGINAL siva O <br />