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UNDERGROUl" TANK PROGRAM OFFICIAL INSPi' TION REPORT <br />SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAMEJ STOCKTON, CA 95205 COUNTY # 3 <br />PHONE NO. 468-3423 <br />SITE NAME: <br />AJn <br />INSPECTION DATE: <br />/ <br />SITE ADDRESS: <br />(� <br />- <br />CITY/STATE/ZIP <br />X15 <br />CHANGES SITE/OWNER/PERMIT? YES <br />FORM A AND/OR B SUBMITTED? <br />NO <br />TANK ( <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK Z <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK_3 <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />PER # <br />EXP ATE <br />TYPE OF INSPECTION <br />NL <br />SITE COMPUTER # <br />/Q-1CJ <br />OPERATIONAL TANK <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 />TANK CONTENTS <br />MAJOR MINOR <br />1 2 <br />f <br />3 4 <br />5 6 <br />7 8 <br />_ <br />9 10 <br />11 12 <br />13 14 <br />15 ZI 16 <br />f <br />17 18� <br />19 20 <br />21 V7 22 <br />23 24 <br />25 26 <br />27 28 <br />29 30 <br />31 32 <br />33 34 <br />35 36 <br />CONDITIONS ABATED //, 37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />SYSTEM STATUS (MUST MARK ONE) <br />MAJOR 5 MINOR 58 NO 59 <br />VIOL.j2f VIOL. ❑ VIOL. ❑ <br />OFFICE: <br />HUT -3 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />FOLLOWS: 15 <br />INSP: RECEIVED BY: <br />TITLE: -e S PHONE <br />ORIGINAL <br />BECK: <br />5/88 O 1 <br />