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SA <br />DIS IC , <br />1601 E. HAZELJON AVE. <br />COUNTY `NAME° <br />" <br />STOCKTON, CA 95205 <br />COUNTY # <br />r <br />PHONE NO. 468-3423 <br />SITE NAME: <br />INSPECTION DATE: <br />SITE ADDRESS: <br />' CITY/STATE/ZIP, <br />CHANGES SITE/OWNER/PERMIT? <br />YES'NO <br />NKTANK <br />` <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTE <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />pe <br />PER # <br />PER # <br />PER # <br />PER # <br />EXP. DATE <br />IEXP. DATE <br />I EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS' <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />APPROVED MONITORING SYSTEM <br />9 110 <br />MONITORING SYSTEM <br />11 12` <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />APPROVED RESPONSE PLAN ' <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS`' <br />31 132 - <br />UNAUTHORIZED RELEASES REPORTED <br />33 34_ <br />SAFETY HAZARD <br />35 136 <br />CONDITIONS ABATED <br />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 />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 /><7 <br />FOLLOWS: '� <br />I <br />'F <br />57 58 <br />59 <br />❑ ❑ <br />LJ <br />VIOL. VIOL..R VIOL. <br />OFFICE: INSP <br />RECEIVED BY: <br />..__ <br />TITLE. <br />PHONE: <br />BECK: <br />HUT -3 <br />FILE COPY <br />else OM <br />