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UNDERGROU TANK PROGRAM OFFICIAL INSP ION REPORT <br />AN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAM STOCKTON, CA 95205 COUNTY #'�� <br />PHONE NO. 468-3423 39 <br />CITY/STATE/ZIP <br />TANK © Z_ <br />COMPUTER <br />NUMBER <br />PER # ��- <br />INSPECTION DATE: <br />TANK 03 TANK b5 <br />COMPUTER COMPUTER �p <br />NUMBER NUMBER <br />PER # 1� r-,- PER # <br />SITE NAME: <br />IMPROPER ABANDONMENT 155 156 M <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SITE ADDRESS: <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS: O_ Z <br />,4v' <br />57 58 59 <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />Nw <br />TANK O <br />FORM A AND/ ITTED? <br />COMPUTER <br />NUMBER <br />TYP OF PSP ITE COMPUTER <br /># <br />�® <br />PER # <br />.EXP: DATE <br />dP9AATllllA4,L TANK <br />TANK CONTENTS <br />nnaJoR MINOR <br />PERMIT TO OPERAT <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS REMOVED <br />40� <br />ACCESS LOCATIONS SEALED <br />41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 <br />45� <br />PERMANENT TANK CLOSURE <br />'pJ�l <br />1 <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />CITY/STATE/ZIP <br />TANK © Z_ <br />COMPUTER <br />NUMBER <br />PER # ��- <br />INSPECTION DATE: <br />TANK 03 TANK b5 <br />COMPUTER COMPUTER �p <br />NUMBER NUMBER <br />PER # 1� r-,- PER # <br />OFFICE: INSP: 04n <br />VloA <br />TITLE: <br />HUT -3 ORIGINAL <br />PHONE: <br />BECK: <br />5/88 01 <br />SAMPLING 53 54 <br />IMPROPER ABANDONMENT 155 156 M <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS: O_ Z <br />,4v' <br />57 58 59 <br />MAJOR MINOR NO <br />Li ❑ <br />VIOL. VIOL. VIOL. <br />OFFICE: INSP: 04n <br />VloA <br />TITLE: <br />HUT -3 ORIGINAL <br />PHONE: <br />BECK: <br />5/88 01 <br />