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UNDERGROUtaiANK PROGRAM OFFICIAL l <br />AN JOAQUIN HEAL DIS T�� <br />REPORT <br />MAJC <br />1601 E. HAZELTON AVE. <br />1 <br />CHANGE IN CONDITIONS TO OPERATE <br />COUNTY NAME .- <br />STOCKTON, CA 95205 <br />PHONE NO. 468-3423 <br />COUNTY # <br />. <br />7 <br />APPROVED MONITORING SYSTEM <br />9 <br />` MONITORING SYSTEM <br />SITE NAME: <br />APPROVED MONITOR FREQUENCY <br />INSPECTION DATE: <br />MONITORING RECORDS MAINTAINED <br />15 <br />ACCESS CASING SECURED <br />17 <br />SITE `ADDRESS: " <br />CITY/STATE/ZIP <br />INVENTORY RECONCILIATION <br />21 <br />r..: <br />23 <br />APPROVED RESPONSE PLAN <br />25 <br />CHANGES SITE/OWNER/PERMIT " YES�j NO <br />TANKI TANK <br />TANK -4 <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER COMPUTER yF <br />COMPUTER <br />COMPUTER <br />SAFETY HAZARD <br />NUMBER NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # <br />PER # PER # <br />PER # <br />PER # <br />} <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />POWER DISCONNECTED <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK <br />MAJC <br />PERMIT TO OPERATE <br />1 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />APPROVED CONSTRUCTION <br />5 <br />'WRITTEN MONITORING PROCEDURES <br />7 <br />APPROVED MONITORING SYSTEM <br />9 <br />` MONITORING SYSTEM <br />11 <br />APPROVED MONITOR FREQUENCY <br />13 <br />MONITORING RECORDS MAINTAINED <br />15 <br />ACCESS CASING SECURED <br />17 <br />PIPING <br />19 <br />INVENTORY RECONCILIATION <br />21 <br />TANK GAUGING <br />23 <br />APPROVED RESPONSE PLAN <br />25 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />SAMPLING <br />29 <br />APPROVED TANK REPAIRS <br />31 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />SAFETY HAZARD <br />35 <br />CONDITIONS ABATED <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />44 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />PIPING <br />48 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE; <br />51 <br />SAMPLING <br />53 <br />IMPROPER ABANDONMENT <br />55 <br />_ t_ <br />SYSTEM STATUS (MUST MARK„ONE) <br />MAJOR 57 MINOR 58 NO 59 <br />VIOL. VIOL. ❑ VIOL. LJ <br />HUT -3 <br />28 <br />30 <br />32 <br />36 <br />37 <br />39 <br />42 <br />43 <br />45 <br />47 <br />49 <br />52 <br />54 <br />56 <br />MARKED ITEMS REPRESENT VIOLATIONS' AND <br />.OWS: <br />RECEIVED BY• <br />IUST BE CORRECTED AS <br />INSP. r-' <br />r <br />TITLE-..,,,,, PHONE: BECK: <br />f, <br />�"` � FILE COPY 5r88 <br />