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UNDERGROU" ► TANK PROGRAM OFFICIAL INSP' TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC'i <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME San T(gagt rl STOCKTON, CA 95205 COUNTY # 39 <br /> PHONE NO. 468-3423 <br /> SITE NAME: eacm INSPECTION DATE: <br /> SITE ADDRESS: ��p5 E F`„ CITY/STATE/ZIP <br /> 0 S�o4s2o3 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK r TANK Z TANK 3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER # NUMBER NUMBER NUMBER NUMBER <br /> PER # PER # PER# PER # <br /> wQp 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 22X Ar- <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 40ME <br /> _ <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 4T4- <br /> OWNER/OPERATOR <br /> 3 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: <br /> 57 59 <br /> C C fi itLCQ�I_�'L G <br /> MAJOR MINOR 58NO <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INSP: rnai l f0 : <br /> fnefYQ- I�vad- l .Tim me Cwfch en <br /> 4log'3*35 525 w. iird St- <br /> TITLE: S. PHONE: BECK: �JSZ.3O <br /> Q.N. <br /> HUT-3 ORIGINAL 5/88 n' <br />