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UNDERGROV ) TX PROGRAM OFFICIAL INS `T!^ REPORT <br /> rj Sid JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA PHONE NO. 468 3 23 COUNTY # <br /> SITE NAME: F r f INSPECTION DATE: <br /> r � <br /> SITE ADDRESS: CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES �NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# Z;'91 PER # PER# PER# <br /> �� �'* ✓° ff 3 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR M{NOR <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 /> _. <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 tlP <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 28 . .- <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 - —. <br /> CONDITIONS ABATED 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 144 145 <br /> PE MA�TANKSURE <br /> REMOVALRM LS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 --•.--__._.__—�_. _ _�_.._.,....,.,,._, .—_-__--- _-�.-,,--_-_�- <br /> MENNA <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: !�• / �`� c� <br /> 57 58 <br /> MAJOR MINOR NO (� � �� �• / y f�< �/ � � �,- .�. /�- J <br /> VIOL. LiVIOL Li ' IOL.L=1 , / r22/11 - j <br /> OFFICE: INSP: r�',fry �j RECEIVED BY: <br /> TITLE: + L ;5 PHONE_ RECK: <br /> HUT-3 OWNER'S COPY SIM OM <br />