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UNDERGROUIS TANK PROGRAM OFFICIAL INSTION REPORT <br /> SAN JOAQUIN HEALTH DISTRICW <br /> �-+ 1601 E. HAZELTON AVE. <br /> COUNTY NAME \,�y� ,^ STOCKTON, CA 95205 COUNTY #�3q <br /> Vel PHONE NO. 468-3423 <br /> SITE NAME: 7) INSPECTION DATE: --/ o-? 3 <br /> SITE ADDRESS: 7�� �� W CITY/STATE/ZIPS,/oG C/ fYQj <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK 0 / TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTE COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER # PER # PER # PER# <br /> 1 ,300 EXP_DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK coN NOR <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 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 35 136 1 _. -. <br /> CONDITIONS ABATED 37VA <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL U43 <br /> FLAMMABLE VAPORS REMOVED _ �..._.._._ <br /> ACCESS LOCATIONS SEALED 2 <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING 5 <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 OO57 6NE)� FOLLOWS. - <br /> MAJOR MINOR ry NO <br /> VIOL VIOL LI VIOL — <br /> OFFICE: INSP RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> NUT-3 ORIGINAL siaa O» <br />