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UNDERGROUNEfANK PROGRAM OFFICIAL INSP&'ION REPORT <br /> V.pAN JOAQUIN HEALTH DISTRICT ' <br /> 1601 E" HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: # INSPECTION DATE: <br /> Flzth <s xX62-17 a3 <br /> SITE ADDRESS: �UD w `� �� 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 /&Cpo` NUMBER I&oo- NUMBER _NUMBER <br /> PER# d/ PER# �? PER # p- PER# <br /> 0 EXP.DATE' EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS '�+�r ; <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 10 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 118 <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 35 36 <br /> CONDITIONS ABATED FREE 37 <br /> TEMPORARY TANK CLOSUREr <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 T <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED =43 x, <br /> [RMaWNER/OPE BMt�6R 44 45 1 <br /> 4 <br /> PRO <br /> "ERMANENT TANK CLOSURE h s y� <br /> OFR RIALS 46 47IPING 48 T <br /> FLAMMABLE VAPORS REMOVED 5D <br /> UNAUTHORIZED RELEASE 51 52 _ <br /> SAMPLI 53 54 <br /> IMPROPER ABANDONMENT 155 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST-MARK ONE) FOLLOWS: l�'`�� 6,1 <br /> MAJOVIOLR <br /> ❑ MINOR ❑ NO <br /> Ll *51 <br /> OFFICE: INSP: d __tv/OL RECEIVED BY: <br /> 3�lbd� <br /> TITLE: �pPHONE: BECK:. <br /> IIS rh�/r. NClt.��r S <br /> seas O <br /> HUT-3 ORIGINAL <br />