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UNDERGROfp TANK PROGRAM OFFICIAL INS CTION REPORT <br /> SAN JOAQUIN HEALTH DISTRIOC <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTNO. 46 95205 COUNTY # 39 <br /> 'r-1 PHONE NO. 468-3423 <br /> SITE NAME: I y Qrl+eC� rC,i ? y INSPECTION DATE: ,� 2 12 <br /> SITEADDRESS: I CRD & - CITY/STATE/ZIP Man+- c_,-) `o 4S3 <br /> CHANGES SITE/OWNER/PERMIT? 01V NO TANK o a I TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? V eS COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER 143101 NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # PER# PER # PER# <br /> C�C)sure- L45 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK coNreNrs <br /> MAJOR MINOR 'F+" <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 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 138 139 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 142 <br /> POWER DISCONNECTED 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 mm <br /> UNAUTHORIZED RELEASE 51 52 <br /> ..__. ..___._..._....,_-- <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: T MCr/c� v�de'r <br /> S LTO I ct In 5 q <br /> 58 <br /> MAJOR 57 MINOR NO 59 L <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: I_�^ PHONE: RECK: <br /> HUT-3 ORIGINAL <br />