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UNDERGRO TANK PROGRAM OFFICIAL INS" ON REPORT <br /> SAN JOAQUIN HEALTH DISTRIC4 <br /> 1601 E. HAZELTON AVE. p <br /> COUNTY NAMES r STOCKTON, CA 95205 COUNTY # ,J 9 <br /> Ci/v,, PHONE NO, 468-3423 <br /> SITE NAME: J INSPECTION DATE: <br /> SITE ADDRESS: CITY/STATE/ZIP C� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK Q ( TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER // COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER 1341 3 NUMBER 3 tp,3 NUMBER NUMBER <br /> 13 3 PER# ' PER# PER* . PER#• <br /> EXP.DATE' EXP_DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CoHMNiS <br /> MAJOR I 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 1,nb o 0,4j 10130 <br /> APPROVED MONITOR FREOUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 u4L& ` <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 I <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> i <br /> TEMPORARY TANK CLOSURE 3. , <br /> N " <br /> REMOVAL OF RESIDUAL 38 139 <br /> FLAMMABLE VAPORS REMOVED 40 j <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED- 43' <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE { <br /> REMOVAL OF RESIDUAL MATERIALS - 46 47 <br /> 77 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 - <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: aZ- s I 6156 4 dff <br /> r <br /> 57 - 58 59 <br /> MAJOOL R ❑ VIOL MINOR ❑ VIOL❑ ALA3 <br /> ! A S <br /> Ol=FICE: INSP <br /> TITLE: *PHOE: J_ RECK: <br /> HUT-3 :O IGINAL <br />