Laserfiche WebLink
UNDERGROUN&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: <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />;YSTEM STATUS (MUST MARK ONE) <br />46 <br />48 <br />50 <br />51 <br />53 <br />55 <br />57 58 59 <br />MAJOR <br />VIOL. ❑ VIOLL..R [:]VIOL. ❑ <br />47 <br />49 <br />M <br />52 <br />54 <br />56 <br />CITY/STATE/ZIP <br />SITE ADDRESS: <br />yUc, <br />h! ! <br />TANK <br />TANK <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />NUMBER <br />NUMBER <br />COMPO ER <br />PER # <br />PER # <br />EXP. DATE <br />NUMBER <br />✓'f0 <br />EXP. DATE <br />SITE COPUTEE�R <br /># <br />ITAYR1NpPE,TIQN <br />PER # <br />Alf ` <br />/ <br />EXP. DATE <br />_ <br />OPERATIONAL TANK <br />TANK CONTENTS <br />. <br />MAJOR I MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12� <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />13 <br />14 <br />�.__. <br />15 <br />16 <br />ACCESS CASING SECURED <br />PIPING <br />17 <br />18 <br />19 <br />120 <br />INVENTORY RECONCILIATION <br />21 <br />122 <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />23 <br />25 <br />124 <br />126 <br />l <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />1 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />(� <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />;YSTEM STATUS (MUST MARK ONE) <br />46 <br />48 <br />50 <br />51 <br />53 <br />55 <br />57 58 59 <br />MAJOR <br />VIOL. ❑ VIOLL..R [:]VIOL. ❑ <br />47 <br />49 <br />M <br />52 <br />54 <br />56 <br />CITY/STATE/ZIP <br />TANK <br />TANK <br />TANK <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />NUMBER <br />NUMBER <br />PER # <br />PER # <br />PER # <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />OFFICE: INSP: /2 RECEIVED BY: <br />TITLE: �� S PHONE: BECK: <br />HUT -3 ORIGINAL sis8 OM <br />