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UNDERGROU�TANK PROGRAM OFFICIAL INS-TION REPORT <br /> SAN JOAQUIN HEALTH DISTRIC <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME S p-�Z STOCKTNO. 46 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> 0SITE NAME: ?'C V - p? J� ® INSPECTION DATE: <br /> SITE ADDRESS: 'OA /_ CITY/STATE/ZIP l� 1 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK 2, TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSP TI N SITE l COMPUTER#C.� PER# PER# PER# PER# <br /> t5A 0t/ EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATI NAL 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 p <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 w <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 37 <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 ww. <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'X 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: Q 2- <br /> MAJOR 57 MINOR 58NO 59 <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INSP: RECEIVED BY: <br /> ,, <br /> TITLE�- +v f PHONE: BECK: <br /> HUT-3 ORIGINAL 5/88 O <br />