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UNDERGROUND TANK PROGRAM OFFICIAL INSPE^TION REPORT <br /> IS AN JOAQUIN HEALTH DISTRICT ` <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: �2 23/ INSPECTION DATE: <br /> SITE ADDRESS: $e tM,I P.0 le CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? Y S NO TANK / TANK Z TANK 3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER ,�j COMPUTERCOMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBE70 00 NUMBER/O� D NUMBER/a � NUMBER <br /> E J C^ PER# / /U/(/ PER# (SNI PER# / J ER # <br /> �Tvp�— EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANKCONMN1s <br /> MAJOR I 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 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 21 122 <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 /> ._...__._------- ------------------ ---.. <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> 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 <br /> MMUUS,T/BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 11 i <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL. ❑ VIOL Li <br /> VIOL <br /> OFFICE: INSP: WK L RECEIVED BY: <br /> TITLE: PHONE: REGK: <br /> HUT-3 ORIGINAL - - s'9R 0, <br />