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UNDERGROlf TANK PROGRAM OFFICIAL INS CTION REPORT <br /> SAN JOAQUIN HEALTH DISTRI <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: ) INSPECTION DATE: <br /> lL /1C�/5 t✓/c>n <br /> SITE ADDRESS: � _ CITY/STATE/ZIP 4� <br /> CHANGES SITE/OWNER/PE MIT? OYES NO TANK TANK z TANK '3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER / COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> tet.. SS PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATI NAL TANKC�000S S <br /> MAJOR woR 'J �jlJU O <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 /> _.. <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 -- <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 &44 <br /> r45 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> ,A <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.IMUST MARK ONE) FOLLOWS: ISS �/yJ v <br /> ti <br /> MAJOR 57 MINOR 58 NO S <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSPI IREC IVIED BY: <br /> -- <br /> TITLE% CJf�S H E: RECK <br /> HUT-3 ORIGINAL siea O, <br />