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UNDERGROU�'TANK PROGRAM OFFICIAL INSP';:.lTIONREPORT x <br /> 'SAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 COUNTY # <br /> COUNTY NAME PHONE NO. 468-3423 a <br /> SITE NAME: — INSPECTION DATE: II <br /> Glr�iv �"c <br /> SITE ADDRESS: k CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER ' CONFUTER COMPUTER <br /> NUMBER 21/��/�� NUMBER NUMBER` d3 'NUMBER` _Ql' j <br /> TYPE OF INSPECTION SITE COMPUTER# PER PER#Z�lf,N-(� PER �y ,.. " PER# '90 . ' p <br /> raok 1;2 42, EXP.DATE EXP.DATE li' EXP.DATE AXP.DATE <br /> TANK caNTer�rs ��".�'�° �: "� :0-1-1. � {l <br /> OPERATIONAL TANK �. <br /> MAJOR MINOR � � <br /> .M " . <br /> PERMIT TO OPERATE 1 2" 1 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 s <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 B <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 ! <br /> APPROVED MONITOR FREQUENCY 13 14 y <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 18 <br /> I <br /> PIPING 19 20 ! <br /> INVENTORY RECONCILIATION 21 22 _ p <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 :h ' <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 2$ <br /> SAMPLING } 29 30 # <br /> APPROVED TANK REPAIRS 31 32 a <br /> UNAUTHORIZED RELEASES REPORTED 33 34 �T <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 7 .I <br /> w t <br /> PrMONrrORI <br /> CLOSU � s <br /> REMOVAL O38 39 <br /> FLAMMABLED 40 <br /> ACCESS 41 42 <br /> POWE IS43 <br /> OWNER/OPI G 44 45 <br /> PERMANENT TANK CLOSURE I �� "K <br /> REMOVAL 4f 47 <br /> PIPING 48 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 _ <br /> SAMPLING 53 54 r ` <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND,MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) -FOLLOWS: r rr Q �I <br /> 1 /4aa/e s� ;. <br /> MAJOR 57 MINOR NO 69 <br /> VIOL. ❑ VIOL. kll_`VIOL.❑ "" <br /> OFFICE: INSP: / 7 RECEIVED BY:' <br /> TITLE: PHONE: <br /> TEK: <br /> �. ei�. .S 41&k-i y&S <br /> HUT-3 ORIGINAL i4 5/aa'.0, <br />