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UNDERGROUP '.TANK PROGRAM OFFICIAL 1NSPI. TION REPORT . <br /> USAN JOAOUIN 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: !a 1 b r E. 0 /�,[, /Q� CITY/STATE%IZIP , - <br /> CHANGES SITE YES NO TANK Q TANK if 0 ,)6- TANK 03 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> I PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE I EXP,PATE EXP.DATE <br /> TANK CONTENTS4 be <br /> ti +cr 1' ,ate. <br /> OPERATIONAL TANK MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 Ip <br /> APPROVED CONSTRUCTION, 5 6 I <br /> WRITTEN MONITORING PROCEDURES 7 8 fI <br /> APPROVED MONITORING SYSTEM 9 10 Ii <br /> MONITORING SYSTEM 11 12 -A- <br /> I{ p <br /> IF 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 it <br /> TANK GAUGING 23 24 II <br /> APPROVED RESPONSE PLAN 25 26 I{ <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING . 29 30 i! <br /> APPROVED TANK REPAIRS 31 32 ! p <br /> UNAUTHORIZED RELEASES REPORTED 33 34 ISI _ <br /> SAFETY HAZARD 35 36 1;1 <br /> CONDITIONS ABATED 37 11 <br /> TEMPORARY TANK CLOSURE rb <br /> REMOVAL OF RESIDUAL 38 39 II <br /> II FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 j <br /> POWER DISCONNECTED 43 11 <br /> OWNER/OPERATOR MONITORING 44 45 I[ <br /> if a� <br /> PERMANENT TANK CLOSURE `ef'5� v ° <" <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 pp <br /> PIPING 48 49 IL <br /> FLAMMABLE VAPORS REMOVED 50 II <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 I{ <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> I SYSTEM STATUS(MUST MARK ONE) f <br /> FOLLOWS: <br /> i <br /> i MAJOR 57 MINOR 58 59 <br /> NO <br /> VIOL. ❑ VIOL. ❑ VIOL.❑ II <br /> II <br /> OFF=ICE: INS <br /> V RECEIVED BY: <br /> TITLE: ' ' PHONE: <br /> HUT-3 ORIGINA.L s as ON. <br />