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UNDERGROU* TANK PROGRAM OFFICIAL INS *TION REPORT <br />SAN JOAQUIN HEALTH DISTRIC <br />` COUNTY NAME Sam 1h U <br />1601 E. HAZELTON AVE. <br />STOCKTON, CA 95205 <br />PHONE NO. 468-3423 <br />COUNTY # '39 <br />SITE NAME: �GI! V ' (�t6jp!::1 <br />40 <br />INSPECTION DATE: <br />SITE ADDRESS: 1030 54 <br />O //, v e- CITY/STATE/ZIP <br />41 42 <br />CHANGES SITE/OWNER/PERMIT? YES NO TANK Q J TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER <br />NUMBER NUMBER <br />TYPE OF INSPECTION SITE CjOMPUTER[# PER # 1'7,041 PER # 170 'y <br />y� <br />1 o GG,9 f &k, I Q T EXP. DATE EXP. DATE <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />COMPUTER <br />NUMBER <br />PER # <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />PERMANENT TANK CLOSURE <br />PERMIT TO OPERATE <br />1 2 <br />47 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />49 <br />- <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES 7 8 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />SAMPLING <br />54IMPROPER <br />MONITORING SYSTEM <br />11 12 <br />56 <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />57 58 <br />ACCESS CASING SECURED <br />17 18 <br />MAJOR MINOR Lj <br />I1�=JJ <br />PIPING <br />19 20 <br />VIOL. VIOL. <br />VNO <br />VIOL. <br />I <br />INVENTORY RECONCILIATION <br />21 22 <br />TANK GAUGING <br />23 24 <br />OFFICE: <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 <br />TITLE:'l�t�(/`v(j�tin.o_ <br />PHO E <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />_ <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 <br />SAFETY HAZARD 35 36 <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 />144 145 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />47 <br />PIPING <br />49 <br />- <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />52 <br />r5l <br />SAMPLING <br />54IMPROPER <br />ABANDONMENT <br />56 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: <br />57 58 <br />59 <br />MAJOR MINOR Lj <br />I1�=JJ <br />VIOL. VIOL. <br />VNO <br />VIOL. <br />I <br />OFFICE: <br />INSP: <br />Q� <br />s'� <br />4 X& 7 <br />TITLE:'l�t�(/`v(j�tin.o_ <br />PHO E <br />HUT -3 ORIGINAL v �vr _� - 5/88 0 <br />