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UNDERGROUWTANK PROGRAM OFFICIAL SAN JOAQUIN HEALTH D STR CTW REPORT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME - $ STOCKTOO. 46N, CA -3423 COUNTY # 3 <br /> (,�, PHONE NO. 468-3423 <br /> SITE NAME: L of- / INSPECTION DATE: <br /> CITY/STATE/ZIPG;7Ya/ <br /> SITE ADDRESS: L4- , C � O <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK 05 TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER # PER # PER # <br /> &j( 'L— t/?3 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK <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 B — <br /> APPROVED MONITORING SYSTEM 9 10 .- -- "- <br /> MONITORING SYSTEM 11 12 (1-E <br /> APPROVED MONITOR FREQUENCY 13 14 (o, -- <br /> MONITORING RECORDS MAINTAINED 15 16 -- <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 -- <br /> INVENTORY RECONCILIATION 21 22 a-3 1D <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 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 944045 � <br /> FLAMMABLE VAPORS REMOVED _... ---------- - <br /> ACCESS LOCATIONS SEALED .-. -... - <br /> POWER DISCONNECTED - - - <br /> 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 <br /> "_ .IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> a a <br /> 57 68 69 <br /> NO r7— <br /> OL. LiVIOLOR ❑ VOL❑ <br /> OFFICE: INSP: Sp4: RECEIVED BY: <br /> TITLE: L ( PHONE: RECK: <br /> �f J siea © <br /> HUT-3 ORIGINAL <br />