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UNDERGROU4TANK PROGRAM OFFICIAL INSP ON REPORT <br /> AN JOAQUIN HEALTH DISTRICW <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 <br /> PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: INSPECTION DATE: 9�6 <br /> SITE ADDRESS: �/ '67 CITY/STATE/ZIP f-1iPl� <br /> CHANGES SITE/OWNER/PERMIT? YES O' TANK / TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTIONSITE COMPU R# NUMBER�� NUMBER NUMBER NUMBER <br /> PER# .( ,dpYJ PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENT <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 i-10- <br /> MONITORING <br /> 10MONITORING SYSTEM 11 12 "" <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> 8 <br /> 20 <br /> ACCESS CASING SECURED 17 1 �" -- <br /> PIPING 1 <br /> INVENTORY RECONCILIATION 211 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 W44457 <br /> FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <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 53 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 /> B?r6 <br /> OFFICE: INSP- RECEIVED BY: <br /> �I�61Y6�i <br /> TITLE: <. PHONE:,,2,, �+��oc) BECK: <br /> HUT-3 ORIGINAL rJ 5/88 OM <br />