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UNDERGROU10 TANK PROGRAM OFFICIAL INSRSTION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMESTOCKTON, CA 95205 COUNTY # ? <br /> ,r ,DCL PHONE NO. 468-3423 CJ <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: �OC�D 5 f' _ CITY/STATE/ZIP Stlt"l <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK j D TANK I ( TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTE COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPIpCTION SITE COMPUTER# PER# PER# PER# - PER# <br /> CE/ EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATI A 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 �"Q <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 _i <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 118 1 _ <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 133 34 _ <br /> SAFETY HAZARD <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 139 <br /> FLAMMABLE VAPORS REMOVED -W <br /> ACCESS LOCATIONS SEALED --------- <br /> 142 <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> 7 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS IMUST MARK ONE) FOLLOWS: ` G <br /> c <br /> MAJOR 5759 <br /> MINOR 58 NO � <br /> VIOL. ❑ VIOL. VIOL.❑ <br /> OFFICE: INS P: RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> ..._ _ �......... 5/88 Om <br />