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UNDERGROUP- TANK PROGRAM OFFICIAL INSP`-TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: IfA INSPECTION DATE: :21- 121"-70 <br /> SITE ADDRESS: Z74 e-10 CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> - <br /> FORM A AND/OR B SUBMITTED? COMPUTE �J COMPUTER 00 COMPUTE v COMPUT R 00 <br /> TYPE OF INSPECTION SITE COMPUTER # <br /> NUMBER / NUMBER (�O� UMBER 10000 NUMBER 1 L <br /> J v �r PER # S` PER # ,� PER <br /> S PER # # <br /> l 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 1 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 120 <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 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 ME <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 -T - <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 ME <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: Z O <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL. VIOL_ ElVIOL.❑ <br /> O <br /> OFFICE: INSf�� RECEIVED BY <br /> TITLE: ! ` S PHONE:/ BECK: <br /> _ z716 7-3Z c1 Z <br /> HUT-3 ORIGINAL 5/88 OM <br />