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UNDERGROUND T"NK PROGRAM OFFICIAL INSPECT°1N REPORT <br />.V JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # -31 <br />PHONE NO. 468-3423 <br />SITE NAME: <br />-171 D <br />INSPECTION DATE: <br />-11-611 <br />SITE ADDRESS: 1,5-7-75-S <br />d <br />ITY/STATE/Z9-14C <br />l „TANK <br />f'G� <br />CHANGES SITE/OWNER/PERMIT? <br />FORM AAND/OR SUBMITTED? <br />YES <br />N <br />TANK �'f <br />COMPUTER II <br />TANK <br />OMPUTER <br />COMPUTE <br />TANK <br />B <br />r/ <br />NUMBERS(�� V <br />PER # �� <br />NUMBV�! l <br />PER # / <br />NUMBER ,WO <br />/// <br />ER # f �� <br />COMPUTER/ <br />NUMBEV�I®(f j <br />ER # <br />TYPE OF INSPE TION <br />SITE COMPUTER # <br />//yy <br />1®/ <br />>� <br />V <br />EXP. DATE/ <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 />~� <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 />_ <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 />mm <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 AND MUS BE CORRECTED <br />AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOVyS:! <br />57 58 <br />9 <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL. VIOL. VIOL. <br />OFFICE: <br />INSP: <br />RECEIV BY: <br />TITLE: <br />PHO <br />BECK: <br />HUT -3 ORIGINAL 5/88 0" <br />