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UNDERGROUP" TANK PROGRAM OFFICIAL INSP' ,TION REPORT <br />SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAMESTOCKTON, <br />,5 /j tiJ <br />CA 95205 <br />PHONE NO. 468-3423 <br />COUNTY # <br />REMOVAL OF RESIDUAL <br />SITE NAME: ILgCe- osr <br />or�NIq- <br />5 6 <br />INSPECTION DATE: 3 � 9 <br />n <br />SITE ADDRESS:dam, <br />41 <br />CITY/STATE/ZIP <br />:5T6 <br />56 <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO <br />TANK / <br />TANK a-- <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMP <br />COMPUTER <br />15 16 <br />NUMBER //� <br />���'r_ <br />PER # <br />EXP. DATE <br />NUMBER J <br />,eCG- <br />PER # <br />EXP. DATE <br />NUMBER <br />P �/ <br />DATE <br />NUMBE <br />PE <br />EXP. DATE <br />TYPE OF INSPECTION <br />�/jO0 � <br />SITE COMPUTER # <br />Q� <br />OPERATIONAL TANK <br />TANK CONTENTS <br />21 22 <br />MAJOR MINOR <br />23 24 <br />_.. <br />25 26 <br />1 <br />2 <br />27 28 <br />PERMIT TO OPERATE <br />CHANGE IN CONDITIONS TO OPERATE <br />APPROVED CONSTRUCTION <br />WRITTEN MONITORING PROCEDURES <br />APPROVED MONITORING SYSTEM <br />MONITORING SYSTEM <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />ACCESS CASING SECURED <br />PIPING <br />INVENTORY RECONCILIATION <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />SAMPLING <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />3 4 <br />47 <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />5 6 <br />ml <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />7 8 <br />56 <br />43 <br />OWNER/OPERATOR MONITORING <br />9 10 <br />45 <br />11 12 <br />13 14 <br />15 16 <br />17 18 <br />19 20 <br />21 22 <br />23 24 <br />_.. <br />25 26 <br />~ <br />27 28 <br />29 30 <br />31 32 <br />33 34 <br />35 36 <br />//, 37 <br />TEMPORARY TANK CLOSURE <br />46 <br />47 <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ml <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />56 <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />46 <br />47 <br />48 <br />49 <br />50 <br />51 <br />52 <br />53 <br />54 <br />55 <br />56 <br />SYSTEM STATUS (MUST MARK ONE) <br />57 58 5 <br />MAJOR MINOR NO <br />VIOL. ❑ VIOL. ❑ VIOL. <br />OFFICE <br />INSP: <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: /4'11 U/6Lf!: %no) s 661'�LGG"�� <br />ITITLE: 66 <br />HUT -3 ORIGINAL <br />RECEIVED BY - <br />o" <br />PHONE: / 'T�Fl I <br />BECK: <br />5/88 01 <br />