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UNDERGROUI&TANK PROGRAM OFFICIAL INSPIVON REPORT <br />'WAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: ��� INSPECTION DATE: <br />SITE ADDRESS: "72�� CITY/STATE/ZIPC <br />CHANGES SITE/OWNER/PERMIT? YES NCf TANK TANK 7 TANK TANK <br />FORM A AND/OR B SUBMITTED? COMPUTER COMPUTEI,,,0V COMPUTER COMPUTER <br />TYPE OF NSPECTION SITE COMPUTER # NUMBEj�i./"� NUMBElf GV NUM NUMBERMw®�i <br />/ PER #� PER # s'� PER # PER # / u` <br />C�j ` ! f I EXP. DATE SL/ EXP. DATE G� V EXP. DATE EXP. DATE <br />OPERATIONAL TA K TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE 1 2 <br />IMPROPER ABANDONMENT 55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND <br />SYSTEM STATUS (MUST MARK ONE) !?Z tri <br />FO OHVS: <br />�.seAs. <br />57 58 59 <br />MAJOR MINORNO 1. <br />VIOL. ❑ VIOL. LiVIOL. ®A/Ao%1,1 / i 4160MI017AY fear <br />OFFICE: I INSP: IAI <br />I HUT -3 <br />A <br />TLE: /� PHONE: � <br />ORIGINAL <br />BE CORRECTED AS <br />mims a 1-2 <br />BECK: <br />Z <br />5/88 <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 />i�� �� <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 />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 />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT 55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND <br />SYSTEM STATUS (MUST MARK ONE) !?Z tri <br />FO OHVS: <br />�.seAs. <br />57 58 59 <br />MAJOR MINORNO 1. <br />VIOL. ❑ VIOL. LiVIOL. ®A/Ao%1,1 / i 4160MI017AY fear <br />OFFICE: I INSP: IAI <br />I HUT -3 <br />A <br />TLE: /� PHONE: � <br />ORIGINAL <br />BE CORRECTED AS <br />mims a 1-2 <br />BECK: <br />Z <br />5/88 <br />