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UNDERGROUP--`TANK PROGRAM OFFICIAL INSPr' `TION REPORT <br /> ',,,,SAN JOAQUIN HEALTH DISTRICT` <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME r r STOCKTON, CA 95205 COUNTY # <br /> �tF J r, ! % v. PHONE NO. 468-3423 -� <br /> SITE NAME: W t J7. �' �� � � ? fir {�� INSPECTION DATE: ,. s; <br /> SITE ADDRESS: (.) / CITY/STATE/ZIP 4 l r J r 1 tit l� /��r l <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK —. TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> r <br /> Co 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 11 112 <br /> APPROVED MONITOR FREQUENCY 13 114 <br /> MONITORING RECORDS MAINTAINED 15 116 <br /> ACCESS CASING SECURED 17 18 ,� y <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 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 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 <br /> FLAMMABLE VAPORS REMOVED 50 / <br /> UNAUTHORIZED RELEASE 51 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS�EPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: •t 58 59 <br /> 7 r <br /> MAJOR 57 MINOR NO <br /> VIOL. VIOL. VIOL.LJ <br /> OFFICE: INSP: RECEIVED BY: <br /> r.0 <br /> TITLE: -�. ��/; ... PHONE: BECK: <br /> HUT-3 FILE COPY 5/88 0M <br />