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UNDERGROIV TANK PROGRAM OFFICIAL IN§CTION REPORT <br />SAN JOAQUIN HEALTH DISTRI <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: %3 <br />INSPECTION DATE: <br />SITE ADDRESS: ®l -tom <br />CITY/STATE/ZIP <br />G,,,,, � <br />ACCESS LOCATIONS SEALED <br />CHANGES SITE YES NO <br />TANK AV <br />TANK JZ <br />TANK 0 3 <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER /?1o0✓ <br />NUMBER /Z, ova <br />NUMBER /2, v -o <br />NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # <br />PER # v�G <br />PER # 5'=,- <br />PER # viL 'L <br />PER # <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK 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 28 <br />SAMPLING 29 30 <br />APPROVED TANK REPAIRS 31 32 <br />UNAUTHORIZED RELEASES REPORTED 33 34� <br />� <br />SAFETY HAZARD 135 36 <br />CONDITIONS ABATED / 37 <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 39 <br />FLAMMABLE VAPORS REMOVED <br />40 <br />95 <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 />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />SYSTEM STATUS (MUST MARK ONE) <br />57 58 <br />MAJORMINOR NO <br />VIOL. ❑ VIOL. ❑ VIOL. <br />■ <br />OFFICE: INSP:�G RECEIVED BY: <br />TITLE:. /`/- s, PHONE: D33� BECK: <br />HUT -3 ORIGINAL 5/88 0M <br />