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,OUNTY NAME <br />UNDERGROUW TANK PROGRAM OFFICIAL INSPF .TION REPORT <br />jpSAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME` rA�Cs e /e- <br />HUT -3 <br />INSPECTION DATE./-/ 3-�3 <br />SITE ADDRESS: © / v R�r�1 <br />CITY/STATE/ZIP <br />4 <br />CHANGES SITE/OWNER/PERMIT? YES NO TANK <br />TANK Z <br />TANK 3 TANK <br />FORM A AND/OR B SUBMITTED? COMPUTER <br />COMPUTER <br />COMPUTER COMPUTER <br />NUMBER <br />NUMBER <br />NUMBER NUMBER <br />TYPEF INSPECTION SITE COMPUTER # <br />%��v � PER # <br />`�� <br />PER # <br />PER # PER # <br />`^ � / �, <br />i` -k EXP. DATE <br />EXP. DATE <br />EXP. DATE 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 18 <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 19 120 <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 />SAFETY HAZARD 35 36 <br />CONDITIONS ABATED 37 <br />TEMPORARY TANK CLOSURE - <br />REMOVAL OF RESIDUAL 38 39 <br />FLAMMABLE VAPORS REMOVED 40 <br />ACCESS LOCATIONS SEALED 41 42� <br />POWER DISCONNECTED 43 <br />OWNER/OPERATOR MONITORING 44 45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS 46 47 <br />PIPING 48 49 <br />�� <br />FLAMMABLE VAPORS REMOVED 50 <br />UNAUTHORIZED RELEASE 51 52 <br />SAMPLING 53 54 <br />IMPROPER ABANDONMENT 55 56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS: <br />57 58 59 <br />MAJORMINOR NO <br />LiVIOL. LiVIOL. <br />VIOL. <br />OFFICE: <br />iNSP:4�0' <br />CEI BY: <br />TITLE: <br />H NE - <br />E: <br />UT --3 ORIGINAL 5/88 <br />