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UNDERGROUlf TANK PROGRAM OFFICIAL INS�TION REPORT <br />SAN JOAQUIN HEALTH DISTRIC <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: <br />INSPECTION DATE: <br />SITE ADDRESS: �. � <br />CITY/STATE/ZIP <br />`w <br />CHANGES SITE/OWNER/PERMIT? YES <br />FORMA AND/OR B SUBMITTED? <br />NO <br />TANK/pivr�c7. <br />COMPUTER SIL <br />NUMBER sO/ <br />EXP. DATE', - <br />TANK /�i�v <br />COMPUTER vl� <br />NUMBER Z <br />EXP. DATE <br />TANK /w,vo' <br />COMPUTER <br />NUMBER ide <br />EXP. DATE <br />TANK <br />COMPUTER <br />NUMBER <br />EXP. DATE <br />TYPE OF INSPECTION SITE CO�jMPUT <br />R # <br />OPERATIONAL TANK <br />TANK CONTENTS <br />OWNER/OPERATOR MONITORING <br />44 45 <br />MAJOR MINOR <br />PERMANENT TANK CLOSURE <br />1 <br />2 <br />PERMIT TO OPERATE <br />PIPING <br />48 49 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />UNAUTHORIZED RELEASE <br />51 52 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />53 54 <br />- <br />IMPROPER ABANDONMENT <br />WRITTEN MONITORING PROCEDURES <br />7 <br />18 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MAJOR MINOR <br />❑ <br />_P <br />MONITORING SYSTEM <br />11 <br />12 <br />VIOL. <br />13 <br />14 <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />17 <br />18 <br />PHONE: <br />ACCESS CASING SECURED <br />PIPING <br />TITLE: %�� /� ' <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 />��� <br />--"-.,_.,_,.._..�....,.._.._.. <br />,.•.,.y.W...� <br />_ " <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />V,37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />ACCESS LOCATIONS SEALED <br />41 42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING <br />44 45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 47 <br />PIPING <br />48 49 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />51 52 <br />m <br />SAMPLING <br />53 54 <br />IMPROPER ABANDONMENT <br />55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 <br />59 <br />MAJOR MINOR <br />❑ <br />NO <br />❑ <br />VIOL. VIOL. <br />VIOL. <br />OFFICE: <br />INSP: <br />i G <br />RECEIVED BY: <br />PHONE: <br />BECK: <br />TITLE: %�� /� ' <br />HUT -3 ORIGINAL 5/88 0f <br />