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UNDERGROUf TANK PROGRAM OFFICIAL INSPI&TION REPORT <br />SAN JOAQUIN HEALTH DISTRICIW <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME:r�� �� <br />INSPECTION DATE:03-// � z <br />�� <br />SITE ADDRESS: ,�/� <br />CITY/STATE/ZIP, Gyp C-* <br />2 <br />'TANK <br />CHANGES SITE/OWNER/PERMIT? YES <br />NO <br />1 TANK 'z TANK "3 TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />COMPUTER COMPUTER COMPUTER <br />NUMBER <br />NUMBER NUMBER NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # <br />� `� <br />PER # <br />PER # PER # PER # <br />1Y'3jf <br />� <br />EXP. DATE <br />EXP. DATE EXP. DATE EXP. DATE <br />OPERATIONAL TANK TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE 1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE 3 <br />4 <br />APPROVED CONSTRUCTION 5 <br />6 <br />WRITTEN MONITORING PROCEDURES 7 <br />8 <br />APPROVED MONITORING SYSTEM 9 <br />10 <br />MONITORING SYSTEM 11 <br />12 <br />APPROVED MONITOR FREQUENCY 13 <br />14 <br />MONITORING RECORDS MAINTAINED 15 <br />16 <br />ACCESS CASING SECURED 17 <br />18 <br />PIPING 19--l'20 <br />INVENTORY RECONCILIATION 21 <br />22 <br />TANK GAUGING 23 <br />24 <br />APPROVED RESPONSE PLAN 25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE 27 <br />28 <br />SAMPLING 29 <br />30 <br />APPROVED TANK REPAIRS 31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED 33 <br />34 <br />SAFETY HAZARD 35 <br />36 <br />_� <br />� �""�'�""�"" -----���•._,._� .______ <br />CONDITIONS ABATED <br />37 <br />- <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL 38 <br />39 <br />FLAMMABLE VAPORS REMOVED 40 <br />ACCESS LOCATIONS SEALED 41 <br />42 <br />POWER DISCONNECTED <br />43 <br />OWNER/OPERATOR MONITORING 44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS 46 <br />47 <br />PIPING 48 <br />49 <br />FLAMMABLE VAPORS REMOVED 50 <br />UNAUTHORIZED RELEASE 51 <br />52 <br />SAMPLING 53 <br />54� <br />R <br />M ~~ <br />IMPROPER ABANDONMENT 55 <br />156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 59 <br />MAJOR MINOR NO <br />❑ ❑ <br />VIOL. VIOL. VIOL. <br />OFFICE: INSPG,� J,// RECEIVE <br />TITLE: PHON BECK: <br />IHUT -3 ORIGINAL 5/85 0m <br />