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UNDERGROWTANK PROGRAM OFFICIAL INSP' TION REPORT <br /> ,AN JOAQUIN HEALTH DISTRICT 4 <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 COUNTY # <br /> COUNTY NAME PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br /> r� -i-S <br /> SITE ADDRESS: CITY/STATE/ZIP •7-acc <br /> C2 Ve41,V-'C <br /> CHANGES SITE/OWNER/PERMIT. YES NO TANK TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# pER# /t/93-03 PER # PER # PER # <br /> c;_3 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL T NK TANK CONTENTS <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 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 128 <br /> SAMPLING 29 130 <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 4p <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> _d <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50ME S(� - 3J� <br /> UNAUTHORIZED RELEASE 51 52 r' <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 66 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 141- so;z 5 —a . <br /> :f6cu1- <br /> 57 5859 <br /> MAJOR MINOR NO <br /> VIOL. LJ VIOL. ❑ VIOL❑ E�XLSQSr�J .r�c� <br /> OFFICE: INSP: G1 ra p 2 RECEIVED BY: <br /> TITLE: S J- PHONE: BECK' <br /> 0 <br />