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UNDERGROUlf TANK PROGRAM OFFICIAL INSP TION REPORT <br />SAN JOAQUIN HEALTH DISTRICIq <br />1601 E. HAZELTON AVE. <br />COUNTY NAME <br />STOCKTON, CA 95205 <br />COUNTY #37 <br />20 <br />PHONE NO. <br />468-3423 <br />5 6 <br />SITE NAME: <br />21 <br />22 <br />/ n <br />INSPECTION DATE: � `-'Z -3 <br />SITE ADDRESS: <br />J I_ CITY/STATE/ZIP <br />" Ct� Cf4 ?15�G7%i1 <br />CHANGES SITE YES <br />NO <br />TANK <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />13 14 <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />NUMBER <br />PER # <br />29 <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />31 <br />ACCESS CASING SECURED <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK TANK CONTENTS <br />MAJOR MINOR <br />PERMIT TO OPERATE 1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />19 <br />20 <br />APPROVED CONSTRUCTION <br />5 6 <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />WRITTEN MONITORING PROCEDURES <br />7 8 <br />TANK GAUGING <br />23 <br />APPROVED MONITORING SYSTEM <br />9 10 <br />APPROVED RESPONSE PLAN <br />11 12 <br />26� <br />MONITORING SYSTEM <br />13 14 <br />27 <br />28 <br />APPROVED MONITOR FREQUENCY <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />29 <br />30 <br />17 18 <br />- <br />31 <br />ACCESS CASING SECURED <br />v <br />TITLE: , 1 PHO E:� <br />C'7 P <br />HUT -3 ORIGINAL <br />AS <br />5/88 01 <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 />mm <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 />OWNER/OPERATOR MONITORING <br />44 <br />45 <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 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABANDONMENT <br />55 <br />56�� <br />TI-Iff M <br />SYSTEM STATUS (MUST MARK ONE) <br />FOL WS: <br />57 58 <br />59 <br />r7 <br />MAJOR MINOR NO <br />LJ <br />❑ <br />In c-li <br />VIOL. VIOL. VIOL. <br />_ <br />v <br />TITLE: , 1 PHO E:� <br />C'7 P <br />HUT -3 ORIGINAL <br />AS <br />5/88 01 <br />