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UNDERGROUl"n TANK PROGRAM OFFICIAL INSP`"TION REPORT <br />SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: <br />' % jl <br />/� D <br />INSPECTION DATE: J I l <br />SITE ADDRESS: -7 <br />l <br />CITY/ST / IP <br />1?afz� <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TA14* <br />TANK I <br />TANK i7 <br />TANK <br />FORM AAND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER"? Q <br />PER # ( <br />COMPUTER 'l <br />NUMBE�i 0 UD Gs <br />PER # / r <br />COMPUTEf,�„ o <br />NUMBE/ (X/ � <br />PER # 7 <br />/ V <br />COMPLI R <br />NUMB <br />PER # (>� <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />U <br />�/ <br />EXP. DATES <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR 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 />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <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 />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 />126 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />128 <br />SAMPLING <br />29 <br />130 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <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 <br />AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 <br />59 <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL. VIOL. VIOL. <br />OFFICE: INSP- <br />"R? <br />El: BY: <br />ITLE: <br />�0-bl <br />�.J�- <br />PHION17��- -)� <br />BECK: <br />1 <br />i <br />.� <br />HUT -3 ORIGINAL 5/88 Oh <br />