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UNDERGROUN - TANK PROGRAM OFFICIAL INSPF'K ION REPORT G Z <br /> SAN JOAQUIN HEALTH DISTRICT ` l 6 <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 <br /> PHONE NO. 468-3423 <br /> SITE NAME: wl Lf/ l GLI�/tid — INSPECTION DATE: 7 %/ <br /> SITE ADDRESS: 5 ! 7 � CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK TANK C Iry TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER ! COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TY P OF INSPRFCTI SITE COMPUTER # PER # PER # PER # PER # <br /> / EXP. DATE - EXP. DATE EXP. DATE EXP. DATE <br /> OPERATIONAL TANK TANK CCNMNM <br /> MAJORMINOR <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 <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 133 134 <br /> SAFETY HAZARD 136 136 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 138 139 <br /> FLAMMABLE VAPORS REMOVED 140 <br /> ACCESS LOCATIONS SEALED 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 440145 <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 /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL ❑ VIOL ❑ VIOL <br /> OFFICE : INSP., 41 <br /> RECEIVED BY: <br /> TITLEi PHONE: RECK: <br /> HUT-3 ORIGINAL siae QM <br />