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UNDERGROU TANK PROGRAM OFFICIAL INSP ION REPORT <br />SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: Jam" /' /' / INSPECTION DATE: <br />SITE ADDRESS: � � � � / O ITY/STATE/ZIP � 23 <br />CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br />FORM A AND/OR B SUBMITTED? COMPUTER '�{ COMPUTER COMPUTER COMPUTER <br />NUMBER , NUMBER NUMBER NUMBER <br />TYPE OF ECTION SITE COMPUTER # O' <br />PER # O�_%L PER # PER # PER # <br />( <br />EXP. DATE." . EXP. DATE 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 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 />SAFETY HAZARD 35 36 <br />CONDITIONS ABATED rZl371:01111; <br />li lig iiiiii'l 111111111i i, lo <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 />FLAMMABLE VAPORS REMOVED 50 <br />UNAUTHORIZED RELEASE 51 52 <br />SAMPLING 53 54 <br />IMPROPER ABANDONMENT 55 156 <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 />LJVIOL. ❑ <br />VIOL. VIOL. <br />OFFICE: <br />INSP: <br />RECEIVED BY: <br />PHONE: <br />RECK: <br />TITLE: <br />HUT -3 ORIGINAL 5/88 0M <br />