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UNDERGROUINWANK PROGRAM OFFICIAL)INSPON o <br /> REPORT <br /> SAN JOAQUIN HEALTH DISTRICT, <br /> ' 1601 E. HAZELTON AVE. I� <br /> - COUWY NAME STOCKTON. CA 95205 1 ` COUNTY # 3 <br /> PHONE NO. 468-3423 ��- k <br /> SITE NAME: p ` ' -;t INSPECTION DATE: <br /> le- 7" I , <br /> SITE ADDRESS: 1 / OG CITYSTATE/Z! <br /> CHANGES SITE/OWNER/PERMIT? YES . NO TANK TANK Z TANK 3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTE - <br /> NUMBER' . NUMBER E NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# ,,. _ <br /> PER# PER#, PER# PER# <br /> � .. <br /> EXP.DATE EXP.DATE 11 EXP.DATE EXP.DATE <br /> """""CONTENTS <br /> OPERATIONAL TANK ' <br /> Mx <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 !.. <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 r <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. I� <br /> ACCESS CASING SECURED 17 18 N <br /> PIPING 19 20 l <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING.. 23 24 11 <br /> APPROVED RESPONSE PLAN 25 26 - <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 . ' 28 IL' ,. <br /> SAMPLING 29 X. <br /> APPROVED TANK REPAIRS 31 32 T . <br /> UNAUTHORIZED RELEASES REPORTED <br /> SAFETY HAZARD 35 36 ! k <br /> CONDITIONS ABATED 37 i} <br /> TEMPORARY TANK CLOSURE <br /> I -W-1 <br /> REMOVAL.OF RESIDUAL 38 39 � a <br /> FLAMMABLE VAPORS REMOVED 40 it F <br /> ACCESS.LOCATIONS SEALED--:-. 41 42 j <br /> POWER DISCONNECTED 43 -• i <br /> OWNER/OPERATOR MONITORING 44 45 I <br /> n , <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS `' 46 47 <br /> PIPING' ' 48' 49 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE _:;, ;. 51 52 I . <br /> SAMPLING 53 54 . <br /> IMPROPER ABANDONMENT, --.'155 56 1 <br /> THE MARKED!TENS REPRESENT VIOLATIONS AND MUST BE CORRECTED-AS _ <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR _57 MINOR 58 NO 59 S „t <br /> VIOL VIOL ❑ of <br /> VIOL ;.Fc <br /> OFFICE: INSP:CtOK 4vtRECEIVED;BY:. <br /> :TITLE: Z-6745 PHONE: c J; BECK <br /> ORIGINAL sraa 'O+ <br /> HUT-3 '. .; r <br /> f �` <br />