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UNDERGROUNTANK PROGRAM OFFICIAL INSP TION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAMESTOCKTON, CA 95205 COUNTY # 3q, <br /> PHONE NO. 468-3423 <br /> SITE NAME: /,i�/. INSPECTION DATE: 3 f 3 <br /> SITE ADDRESS: � pm-t sr. CITY/STATE/ZIP Lp� <br /> CHANGES SITE/OWNER/PERMIT? YES N TANK TANK d Z TANK � TANK D� <br /> FORM A AND/OR B SUBMITTED? 5 COMPUTERO� COMPUTER COMPUTEFPp� COMPUTER <br /> TYPE OF INSPECTION SITE COM UTER# NUMBER NUMBER NUMBER NUMBER <br /> J <br /> 177 <br /> i PER# PER# PER# PER# <br /> �i l7 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MNK CONreNT <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 V <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 N37 <br /> APPROVED RESPONSE PLAN <br /> UNAUTHORIZED RELEASE OCCURRENCE <br /> SAMPLING <br /> APPROVED TANK REPAIRS - <br /> UNAUTHORIZED RELEASES REPORTED <br /> SAFETY HAZARD <br /> CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W4445 <br /> FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> _. <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: Z <br /> 58 59 <br /> VIOL MAJOR 5� MINVIOL. NO <br /> ❑ - VOL❑ <br /> OFFICE: INSP: i/yJ/ �/ RECEIV D BY: <br /> 7T TITLE: ��,�5, PHONE: PECK: <br /> HUT-3 ORIGINAL 5188 OM <br />