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UNDERGROfp TANK PROGRAM OFFICIAL INS�(CTION REPORT <br /> SAN JOAQUIN HEALTH DISTRIG� <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 <br /> PHONE NO. 468-3423 COUNTY # <br /> SITE NAME: " INSPECTION DATE: / / <br /> r cr G ' _ �f-3�`-�' !l <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANI< TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTIONCOMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> !, _n PER# PER# PER# PER # <br /> !]SITE EXP.DATE EXP.DATE EXP_DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 <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 17 118 <br /> PIPING 19 F0 <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 31 132 <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 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOV 80UAE-M#fEIRIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <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: _ / r <br /> MAJOR 57 MINOR 58 NO 59zb <br /> /^ <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> HUT-3 OWNER'S COPY siea ©M <br />