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UNDERGRODUTANK PROGRAM OFFICIAL INP ION REPORT <br /> AN JOAQUIN HEALTH DISTRI <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> /� PHONE NO. 468-3423 <br /> SITE NAME: &OL;60 C JS LC/' INSPECTION DATE: <br /> SITE ADDRESS: J CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? Y NO TANK 01 TANK QZi TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TypE-OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> n 1 6o-3 PER # PER# PER# PER# <br /> K 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 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 v <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 3'7 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED 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 RER51ESEN VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) 9/ FOLLOWS: <br /> 57 58MAJOR MINOR NO 51� - <br /> VIOL. VIOL. VIOL.LJ <br /> OFFICE: INSP:/ /.,k) ®p RECEIVED BY: <br /> TITLE: less, PHONE. BECK: <br /> HUT-3 ORIGINAL <br />