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UNDERGROU!" TANK PROGRAM OFFICIAL INSPrTION REPORT <br /> ,-SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTI # <br /> PHONE NO. 468-3423 <br /> SITE NAME: 2 <br /> 5 17 T 40 --Z;a L INSPECTION DATE: <br /> SITE ADDRESS: im/ 3� FY t�„Ae-i lr0 f* CITY/STATE/ZIP` 9r-,7 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK ' TANK TANK -�, TANK IL <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTE COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER �/0 NUMBER �',y(�}y NUMBER NUMBER <br /> J PER# r PER# I+ PER# PER# <br /> �[ 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 x <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 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <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 /> 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 REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS:—suQ 2- <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL ❑ VIOL.❑ <br /> OFFICE: INSP:jW RECEIVED BY: <br /> TITLE: A�— PHONE: RECK: <br /> HUT-3 ORIGINAL Sias ©, <br />