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UNDERGROUI TANK PROGRAM OFFICIAL INSP' -TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 34?PHONE NO. 468-3423 <br /> SITE NAME: �O r{- U W cr4-t .� F'o 0 o s INSPECTION DATE V t� ? <br /> SITE ADDRESS: 111,50 E m i n e N c•� CITY/STATE/ZIP St.,, q <br /> �A 5.;a 7 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK ©/ TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER p NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# i / p w PER# PER# PER # <br /> r u'•• {SLR- , 1 6 (p 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 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING -2930 <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 W43 <br /> 39 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING 457 u <br /> PERMANENT TANK CLOSURE <br /> nx,) <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) F LLOWS: / ed fAA� <br /> r <br /> MAJOR � MINOR NO 59 S C A-4.1 <br /> VIOL. VIOL. VIOL. I I /C r <br /> y. ' r-tr <br /> / tk— ' <br /> OFFICE: INSP: N/Gti/eo( 'fo S <br /> ori' of S-Acefw�. FoodslXnc. <br /> . O. 3 <br /> TITLE:En0 rorW,4.4aA PHONE: {¢.p,.1I CO <br /> P al <br /> HUT-3 ORIGINAL Sias O, <br />