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UNDERG ROUblik TANK PROGRAM OFFICIAL INSP TION <br />REPORT <br />SAN JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME <br />STOCKTON, CA 95205 <br />COUNTY # <br />PHONE NO. 468-3423 <br />e~ <br />SITE NAME: -7- <br />IT/. <br />INSPECTION DATE: <br />lg- <br />SITE ADDRESS: J 1 , CITY/STATE/ZIP <br />Z6 { <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />N TANKTANK 06 <br />TANK 07 <br />TANK � <br />FORM A AND/OR B SUBMITTED? <br />COMPUTERl COMPUTER <br />COMPUTER <br />COMPUTER <br />TY5 OF INSPECTION SITE COMPUTER <br /># <br />NUMBERS -m-x NUMBER p U/ <br />NUMBER <br />NUMBER <br />_ <br />r <br />PER # PER # <br />PER # <br />PER # <br />EXP. DATE EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />_ <br />APPROVED CONSTRUCTION <br />5 <br />6___ .._._ <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 ✓ ✓ <br />✓ <br />✓ <br />MONITORING SYSTEM <br />11 <br />12 _ <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 ill�— <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 />n <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 />FLAMMABLE VAPORS REMOVED <br />40ACCESS <br />q45 <br />LOCATIONS SEALED <br />41 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />44 <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 _w <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 />58 <br />59 <br />MAJOR Lj MINOR NO <br />LJ <br />VIOL. VIOL. VIOL. <br />OFFICE: <br />INSP7 <br />RECEIVED BY: <br />" t " z <br />PHONE: <br />BECK: <br />TITLE: <br />HUT -3 <br />ORIGINAL <br />5/88 0" <br />