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UNDERGIITANK PROGRAM OFFICIAL INSF <br /> SAN JOAQUIN HEALTH DISTRICT <br /> ' ON REPORT <br /> 1601 E. HAZELTON AVE. q <br /> COUNTY NAME `} STOCKTON, CA 95205 COUNTY # 3 / <br /> SaIVA PHONE NO. 468-3423 q. <br /> INSPECTION DATE: <br /> SITE NAME: <br /> SITE ADDRESS: aU` rVLCITY/STATE/ZIP S-kGj��., l /7 ��gOrD <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK D 1 TANK O :;1- TANK !U 3 TANK O�f <br /> FORM A Al B SUBMITTED? OMPUTER OMPUTER OMPUTER OMPUTER <br /> UMBER UMBER UMBER UMBER <br /> TYPE OF INSPECTION SITE COMPUTER# P R# P R# P R# R# <br /> 3 E DATE E DATE E .DATE E P.DATE <br /> OPERATIONAL TANK TANK R <br /> MAJORR MMINOINOR <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 f (iC. (I. Ir i- F7 APPROVED MONITOR FREQUENCY 13 14 (0)MONITORING RECORDS MAINTAINED 15 16ACCESS CASING SECURED 17 18 CG �-3 <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 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4142 <br /> 9 _ <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTED 3 OWNER/OPERATOR MONITORING 5 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 _ <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50RE <br /> �...._._. / <br /> UNAUTHORIZED RELEASE 51 52 _ ✓ _. <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 156 - <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> i <br /> MAJOR �57y/ MINOR 58 NO 59 <br /> VIOL. LYJ VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: . C(> RECEIVED BY: <br /> TITLE: Q S PHONE: BECK: <br /> HUT-3 ORIGINAL <br />