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UNDERGROUNn TANK PROGRAM OFFICIAL INSPF"'TION REPORT <br /> SAN JOAQUIN HEAoLTH DIST -T' <br /> 1601 E. HAZELTAVE, <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: // INSPECTION DATE: <br /> SITE ADDRESS: -77 7 oc-�.5�- ,l <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK Z TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYP OF INSPECTIONSITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> p PER # PER# PER# PER# <br /> _ ] <br /> t' ✓��`/ 73 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 9 110 <br /> MONITORING SYSTEM 11 112 <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 135 136 1 <br /> CONDITIONS ABATED ML 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 --�-_ --—� <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE r <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING A 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 _— <br /> SAMPLING 3 54 — -- - <br /> IMPROPER ABANDONMENT 55 56 ----- ---___—_ <br /> KED ITEMS REPRESENT VI UST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO <br /> VIOL. ❑ VIOL. ❑ VIOL Lef <br /> OFFICE: INSP- RECEIVED BY: <br /> _ G <br /> TITLE: g�s ONE: BECK: <br /> HUT-3 ORIGINAL siss <br />