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UNDERGROUP" TANK PROGRAM OFFICIAL INSPF"TION REPORT <br /> 3AN JOAQUIN HEALTH DISTRIC,.) <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME �y STOCKTON, CA 95205 COUNTY # 3 / <br /> (] <br /> %� � PHONE NO. 468-3423 <br /> SITE NAME: /,�lINSPECTION DATE: -9-c�z <br /> SITE ADDRESS: 3� s CITY/STATE/ZIP <br /> CHANGES SITE/OWN IT? YES TANK TANK TANK ANK I k <br /> FORM RAND/O SUBMITT S COMPUTER COMPUTER 9- 1.11MBER <br /> MPUTER COMPUTER S <br /> TYP OF INSPECTI N iTE COMPUTER# NUMBER NUMBER NUMBER <br /> U�� 2� PER# PER# # PER # i <br /> ejr7EXP.DATE' EXP.DATE X .DATE EXP.DATE 1 <br /> TANK CONTENTS .. �,�_ •..._ " • <br /> OPERATIONAL TANK <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <br /> i <br /> WRITTEN MONITORING PROCEDURES 7 .8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11 12 j <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 - <br /> ACCESS CASING SECURED 17 118 <br /> PIPING 19 120 <br /> INVENTORY RECONCILIATION 21 22 _ <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 i <br /> SAMPLING 29 30 { <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> M <br /> TEMPORARY TANK CLOSURE NA`K °�'�` <br /> �x <br /> i <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 144 45 <br /> ctMANEN TANK CLOSURE <br /> OF RESIDUAL M 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASEt55 <br /> 52 <br /> SAMPLING 54 <br /> IMPROPER ABANDONMENT 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST E CORRECTED AS h <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: ,le-d=6-1 rl�l,!71LQ�lcf1?�- <br /> 57 58 59 <br /> MAJORMINOR NO !� <br /> VIOL. LiVIOL. ❑ VIOL. <br /> 'I <br /> OFFICE: INSP: Gf w ���y� RECEIVED BY: <br /> TITLE. 5 PHONE: BECK: <br /> HUT-3 ORIGINAL s as <br />