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UNDERGROUN§JANK PROGRAM OFFICIAL INSP ION REPORT �°�% Z` ° <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:t� „ <br />, J �` .w S <br />�, INSPECTION DATE: <br />SITE ADDRESS: 0 <br />6�? �� <br />CITY/STATE/ZIP C�L <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO TANK <br />TANK TANK TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER <br />COMPUTER COMPUTER COMPUTER <br />NUMBER NUMBER NUMBER or" <br />TYPE OF INSPECTION SITE COMPUTER # <br />PER # / <br />PER # PER # PER # <br />1-7 <br />EXP. DATE <br />EXP. DATE EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINORIN <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8� <br />a <br />APPROVED MONITORING SYSTEM <br />9 <br />0 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED - <br />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 />4 <br />OWNER/OPERATOR MONITORING <br />44 <br />45 <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />146 <br />147 <br />PIPING <br />148 <br />149 <br />FLAMMABLE VAPORS REMOVED <br />50 <br />UNAUTHORIZED RELEASE <br />SAMPLING 53 54' <br />IMPROPER ABANDONMENT 155 156 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS: OF <br />57 58 59 <br />MAJOR MINOR NO <br />Al - <br />VIOL. VIOL. ❑ VIOL. ❑ <br />OFFICE: <br />INSP: <br />TITLE: <br />RECEIV�Y: <br />PHONE: C <br />i�2 <br />IHUT -3 ORIGINAL 5/88 Cl <br />