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UNDERGROUIPTANK PROGRAM OFFICIAL INSION REPORT <br /> SAN JOAQUIN HEALTH DISTRICIW <br /> 1601 E. HAZ AVE. <br /> COUNTY NAME n STOC CA 9 95205 <br /> PHONEE NO. CA NO. 468-3423 COUNTY # <br /> SITE NAME: / INSPECTION DATE: <br /> SITE ADDRESS: �✓ CITY/STATE/ZIP R <br /> sz- <br /> CHANGES SITE/OWNER/PERMIT? E NO TANK pJ TANK pZ TANK p TANK a� <br /> FORM A AND/OR B SUBMITTED? 1&5- p(M COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSP C ION SITE COMPUTER# <br /> 11-Q.� pk�2 D PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATI NAL 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 15 116 1 -- -'- <br /> ACCESS CASING SECURED 17 18 " <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 131 132 <br /> UNAUTHORIZED RELEASES REPORTED33 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 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: O?ff� 2- <br /> MAJOR 57 MINOR 58 NO y59 <br /> VIOL. ❑ VIOL ❑ VIOL IJ <br /> OFFICE: INSP: I /`, e� / !� RECEIVED <br /> TITLE: j�z PHONE: BECK: <br /> u eT .. noir_inini 5/88 �° <br />