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UNDERGRQI!' TANK PROGRAM,OFFICIAL INSf_`TION REPORT <br /> ' AN JOAQUIN HEALTH DISTRICi�,J <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br />!I SITE ADDRESS: CITY/STATE/ZIP <br /> �P 7 <br /> CHANGES SITE/OWNER/PERMIT? ' YES NO TANK / TANK TANK TANK <br /> FORMA AND/OR B,SUBMITTED?,.. _ • COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# PER# PER# <br /> EXP.DATEEXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MIN09 <br /> PERMIT TO OPERATE 1 <br /> CHANGE.IN.CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 _ �! <br /> APPROVED MONITORING SYSTEM 9110, <br /> � � _ <br /> MONITORING SYSTEM 11 _ <br /> APPROVED MONITOR FREQUENCY13 14 <br /> MONITORING RECORDS MAINTAINED 15' 16 <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 <br /> INVENTORY RECONCILIATION 27722 T <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE,PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING P9 30 <br /> APPROVED TANK-REPAIRS 31 32 <br /> UNAUTHORIZED-RELEASES REPORTED. 33 34 v <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS;ABATED 37 <br /> 'TEMPORARY TANK>CLOSURE .. <br /> {REMOVAL.OF.RESIDUAL 38 39 <br /> i FLAMMABLE V,APORS REMOVED <br /> _ <br /> ACCESS.LOGATIONS SEALED 41 42 <br /> ,POWER DISCONNECTED <br /> ,OWNER/.OPERATOR MONITORING 144 45 <br /> ,RERMANENT TANK CLOSURE <br /> -.REMOVAL OF;RESIDUAL MATERIALS ' 46 47 <br /> � iPIPIN.G. 48 49 <br /> FLAMMABLE VAPORS.REMOVED 50 _ <br /> tUNAUTHORIZED,IiELEASE -• j 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 lM MARK,ONE) FOLLOWS:..:../ ti <br /> tMA.IOR{{57 }MINOR (No <br /> 59 - <br /> ;VIOL 1 VIOL !Q t:VIOW <br /> rrr- <br /> i OFFICE: } IN RECEIVED BY: <br /> F I <br /> TI L PHONE: BECK: <br /> I <br /> IHUT•-3 ORIGINAL 5/88 OM <br />