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COUNTY NAME <br />UNDERGROUND `'ANK PROGRAM OFFICIAL INSPEC "ON REPORT <br />,.,AN JOAQUIN HEALTH DISTRICT .� <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 <br />PHONE NO. 468-3423 <br />COUNTY # 71 <br />SITE NAME. <br />L <br />INSPECTION DATE:r- 7 3 <br />Q <br />SITE ADDRESS: +p S�i <br />CITY/STATE/ZIP <br />LI Jl�ji <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK �J_ <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER/ <br />COMPUTED, <br />COMPUTE <br />COMPUTER <br />NUMBER NUMBER V ` <br />PER # �� <br />NUMBER2 <br />PER # 7 o <br />UMBER <br />PER # <br />TYPE OF I PECTION <br />SITE CO P TSR #, <br />EXP DATE <br />P DAT <br />XP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR I MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />_ <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />_ <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />_ <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />133 <br />134 1i <br />SAFETY HAZARD <br />135 <br />136 1_. <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />7 <br />ACCESS LOCATIONS SEALED <br />W <br />2 <br />_ _POWER <br />DISCONNECTED <br />3OWNER/OPERATOR <br />MONITORING <br />5 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE COR¢ECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />4tl' <br />57 58 <br />59 <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL. VIOL VIO <br />_ <br />v 2 <br />i oG <br />A/ Ci <br />M <br />169orn <br />OFFICE: <br />INSP: {, <br />C I ED BY: n <br />TITLE�,G.�.r <br />PH 11,41 <br />BECK: <br />HUT -3 ORIGINAL <br />Gies Om <br />