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UNDERGROU" " TANK PROGRAM OFFICIAL INSF `TION REPORT <br /> '-.,,..wAN JOAQUIN HEALTH DISTRICT-,,-, <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME � .7 �,(( C� j�.�, STOCKTON, CA PHONE NO. 4 890 3423 5205 COUNTY # 't <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: d 'lb �� �, v- � ( �� - � CITY/STATE/ZIP E � �� r�5 y <br /> CHANGES SITE/OWNER/PERMIT? YES Nd TANK 0-{ TANK 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 /> r D v fr tv, /03& PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE 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 C ) <br /> PIPING 19 20 ]1 <br /> INVENTORY RECONCILIATION 21 22 P� 3 �jf [ <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 td <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED V, 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 y <br /> FLAMMABLE VAPORS REMOVED 50 mm <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR NO <br /> VIOL. ❑ VIOL. 58 59 <br /> VIOL.❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: I PHONE: r�r v C RECK: <br /> HUT-3 FILE COPY 5/88 0M <br />