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r } <br /> w UNDERGRO( TANK PROGRAM OFFICIAL INSlw)-TION REPORT <br /> SAN JOAQUIN HEALTH DISTRICT'-,i <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> ,4 PHONE NO. 468-3423 ,3 <br /> SITE NAME: � O INSPECTION DATE: <br /> SITE ADDRESS: I CITY/STATE/ZIP� <br /> 10 H wy I , Poi C 953Co(o <br /> CHANGES SITE/OWNER/PERMIT? YES NO) TANK Ig4to-4I TANK lg4v,-O2- TANK jCj4(a TANK <br /> FORM A AND/OR B SUBMITTED?—R COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER�y] G�?�j NUMBER 1� NUMBER3oO NUMBER <br /> PER# , p;ig S / PER# PER# y� PER# <br /> E 19 tQ EXP.DATE' �j EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 <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 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 - _ ----- w <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 - <br /> SAMPLING 29 30 --- -�� ---�-- - - - _� <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 134 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 - <br /> TEMPORARY TANK CLOSURE `+ <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40ME <br /> — <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 144 145 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 --- <br /> FLAMMABLE VAPORS REMOVED - <br /> UNAUTHORIZED RELEASE 51 52 -� <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONEI FOLLOWS: <br /> -4:Shdode <br /> rx <br /> MAJOR 57 MINORS 58 Np 59 <br /> VIOL.f Ll V(OL. VIOL. <br /> OFFICE: INSP: -y -;I EY RECEIVED BY: <br /> TITLE: A)4 PHONE: IRECK: <br /> I-II IT—Z noirminI Sicv rnw <br />