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UNDERGROUl" TANK PROGRAM OFFICIAL INSPF"TION REPORT <br /> ;AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME �` /y STOCKTON, CA 95205 COUNTY # <br /> J <br /> .�.� �vl J PHONE NO. 468-3423 <br /> SITE NAME: l Q n ' , IpG� /� l�� INSPECTION DATE: J,57' L�Z <br /> SITE ADDRESS: n 9 Clu <br /> bweA CITY/STATE/ZIP-•f�� C4 2& <br /> CHANGES SITE/OW T? Y NO TANK C I TANK _ TANK (`j3 < TANK <br /> FORM A AND/WB SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TY E OF INSPECTI ER# PER # PER# PER # PER # <br /> �V! 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 <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 135 36 <br /> CONDITIONS ABATED rX37 VA <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40ME <br /> _ <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED M 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> R L OF RES RIALS 46 47 ' <br /> /gyp <br /> PIPING 4B 9 � / c-/m P <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 / <br /> IMPROPER ABANDONMENT 55 156 / <br /> THE MARKED ITEM9 REPRESENT VIOLATIONS AND MUST IBEORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: h <br /> 57 58 59 <br /> MAJOR ❑ MINOR ❑ NO <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: j PHONE: RECK. <br /> HUT-3 ORIGINAL saa <br />