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UNDERGROUI'' TANK PROGRAM OFFICIAL INSP "TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: /as/9 <br /> SITE ADDRESS: CITY/STATE/ZIP 5 Aq��n <br /> $. lrcJr�Svn 1stJ"Ca_ r <br /> CHANGES SITE/OWNER/PERMIT? YES NO i TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE 01=INSPECTION SITE COMPUTER# PER #`�9 y-C��- PER# ��`�,��O� PER# PER # <br /> zp ' / x / EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK <br /> TANK eoNTeNTs <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 <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 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 MM <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED mm 43 <br /> OWNER/OPERATOR MONITORING 44 45 <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 53 104 <br /> IMPROPER ABANDONMENT 55 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS ANDZSTBE�ORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) � <br /> FOLLOWS: <br /> Vic frim a <br /> MAJOR 57 MINOR 58 NO 59 n <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INSP: RECEI D BY� kvIV) <br /> TITLE: SENIOR REGISTERED ENVIIMETAL HEALTH H SrfCIALIST BECK: <br /> 5/68 <br /> HUT-3 ORIGINAL <br />