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UNDERGROUNDTANK PROGRAM OFFICIAL INSPr-'M ION REPORT P /1/ OF <br /> AN JOAOUIN HEALTH DISTRI <br /> 1601 E. HAZELTON AVE. <br /> NAK <br /> STOCKTONCA206 <br /> P14ONENO. 468 3 CO # 3 9 <br /> SITE NAME: INSPECTION DATE: <br /> SITE ADDRESS: <br /> ITY/STATE/Z1PS7i�i C11670' 11 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK /O TANK �� IANK' <br /> ORM A AND/OR B SUBMITTED? COMPUTER COMPUTERCOMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER,� NUMBER yDdn' . NUMBER -SQ NUMHER SD COMPUTER <br /> PER# •# ` PER# O i/ S V IV 0/ *A# <br /> EXP.DATE• EXP.DATE EXP,DATE tXXP,p <br /> OPERATIONAL TANK TAM COUnW s <br /> ATE <br /> PERMIT TO OPERATE MAJOR 1 WNM1 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 RECONCRIATION 21 22 <br /> TAMC 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 33 134 <br /> SAFETY HAZARD 35 38 <br /> CONDITIONS ABATED - <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL.OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40ME <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 - <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 50ME <br /> - !— <br /> UhIAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 - <br /> IMPROPER ABANDONMENT rt r� - <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) <br /> FOLLOWS: <br /> 57 58 <br /> MAJOR MIN N <br /> 59 <br /> VIOL ❑ VIOL ❑ VIOL❑ <br /> OFFICE: INSP: /, t7 RECEIVED BY: <br /> TITLE: R�'r�I� PHONE: REGK: <br /> HUT—1 Ot"(VAIAI <br />