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UNDERGROUbTANK PROGRAM OFFICIAL INSP TION REPORT <br />AN 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 />� <br />e, ok`� e�CGs � ccJ <br />SITE ADDRESS: cC CITY/STATE/ZIP <br />M o_ /vl <br />CHANGES SITE/OWNER/PERMIT? YES NO TANK / <br />TANK Z <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />NUMBER <br />NUMBER <br />NUMBER <br />TYPE OF INSPECTION SITE COMPUTER # PER # <br />PER # <br />PER # <br />PER # <br />P--4� v+✓IL W f EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />MAJOR MINOR <br />47 <br />PIPING <br />48 <br />PERMIT TO OPERATE <br />1 2 <br />_ <br />ww <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />SAMPLING <br />53 <br />54 <br />APPROVED CONSTRUCTION <br />5 6 <br />56 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />FOLLOWS: <br />APPROVED MONITORING SYSTEM <br />9 10 <br />- <br />59 <br />MONITORING SYSTEM <br />11 12 <br />VIOL. VIOL. VIOL <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />17 18 <br />- <br />ACCESS CASING SECURED <br />PIPING <br />19 20 <br />INVENTORY RECONCILIATION <br />21 22 / <br />/ <br />�- <br />23 24 <br />TANK GAUGING <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 32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 - 34 <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />,1, 37 <br />TEMPORARY TANK CLOSURE <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 <br />55 <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />C <br />59 <br />MAJOR MINOR � NO <br />lK <br />VIOL. VIOL. VIOL <br />OFFICE <br />TITLE: /J, . <br />100 <br />I BECK: <br />' HUT -3 ORIGINAL 5/88 v <br />