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UNDERGROUNP-TANK PROGRAM OFFICIAL INSPEr'ON REPORT <br />XN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME:' INSPECTION DATE: <br />SITE ADDRESS: ('. � CITY/STATE/ZIP q�376 <br />CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK % 0 <br />FORM A AND/OR B SUBMITTED? COMPUT po COMPUTER COMP T R COMPUTER 'h, , <br />TYPE OF INSPECTION SITE COMPUTER # NUMBE NUMBElo � NUMB n -o NUMBER �� V <br />PER # � PER # l � PER # U PER # <br />o �$ EXP. DATE/� EXP. DATE EXP. DATE I v 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 20 <br />INVENTORY RECONCILIATION 21 22 <br />TANK GAUGING 23 24 <br />APPROVED RESPONSE PLAN 25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE 27 128 <br />SAMPLING 29 30 <br />APPROVED TANK REPAIRS 31 32 <br />UNAUTHORIZED RELEASES REPORTED 33 34 <br />SAFETY HAZARD 35 36 <br />CONDITIONS ABATED //, 377/7 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />zz <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />48 49 <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />46 47 <br />48 49 <br />50 ME <br />51 52 <br />53 54 <br />55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: <br />SYSTEM STATUS (MUST MARK ONE) <br />57 58 <br />MAJOR VIOL. ❑ MINVIOLL..R ❑ <br />59 <br />VOL. INS <br />nxo,, — )s b_- -� iA <br />OFFICE: <br />I INSP: <br />..,A-AJ7 <br />IREC4NED BY: <br />TITLE: < � / I PH BECK: <br />+UT -3 ✓ ORIGINAL <br />5/88 0 M <br />