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UNDERGROUr TANK PROGRAM OFFICIAL INSP! 'TION REPORT <br /> ` '%- SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAIVE �Gliyl 4oSTOCKTON, CA 95205 COUNTY #,3 ? <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: Q7 N, 1i{Ji I czt lr� CITY/STATE/ZIP Sf <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK G TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE JCOMPUTER# PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS ae; ; <br /> . . <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 _- <br /> MONITORING SYSTEM 11 112 Ta <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 _ <br /> PIPING 19 20 �7 <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 35 136 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 M <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED M 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 4$ 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(MUS7 MARK ONE) FOLLOWS: <br /> 59 <br /> MAJOR 57 MINOR 0NO <br /> VIOL. VIOL. VIOL.LJ <br /> OFFICE: RECEIVED 8Y: <br /> TITLE: F E t CS PHONE: BECK: <br /> NUT-3 ORIGINAL �" <br />