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I UNDERGROUND TANK PROGRAM OFFICIAL INSPEC N REPORT <br />JOAQUIN HEALTH DISTRICT <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON, CA 95205 COUNTY # <br />PHONE NO. 468-3423 <br />SITE NAME: 0111C N� �-INSPECTION DATE: <br />SITE ADDRESS: -75;-- �, ��'��� CITY/STATE/ZIP- � <br />CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK may. TANK TANK (�G <br />FORM A AND/OR B SUBMITTED?COMPUTER COMPUTE COMPUTTCOMPUTER/ <br />TYPE OF INSPECTION SITE COMPUTER # NUMB NUMBE �� NUMBE NUMB <br />j� / PER # ®�� PER # ,�y�p e/ PER # a U PER #� <br />!� /U ff/ EXP. DATE EXP. DATE EXP. DATE EXP. DATE <br />OPERATIONAL TANK <br />17 <br />TANK CONTENTS <br />PIPING <br />19 <br />20 <br />MAJOR MINOR <br />INVENTORY RECONCILIATION <br />21 <br />PERMIT TO OPERATE <br />1 <br />2 <br />24 <br />CHANGE IN CONDITIONS TO OPERATE <br />25 <br />3 <br />4 _ <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />APPROVED CONSTRUCTION <br />40 <br />5 <br />6 1 <br />30 °- <br />41 <br />WRITTEN MONITORING PROCEDURES <br />31 <br />7 <br />8 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />APPROVED MONITORING SYSTEM <br />44 <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />46 <br />47 <br />APPROVED MONITOR FREQUENCY <br />48 <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 />38 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 <br />40 <br />SAMPLING <br />29 <br />30 °- <br />41 <br />APPROVED TANK REPAIRS <br />31 <br />32 <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />34 <br />44 <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />FQ37 <br />TEMPORARY TANK CLOSURE <br />'w,• ua <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 50 <br />UNAUTHORIZED RELEASE 51 52 <br />SAMPLING 53 54 <br />IMPROPER ABANDONMENT 55 56� <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) FOLLOWS- <br />57 58 59 <br />MAJORMINOR NO <br />VIOL. ❑ VIOL. ❑ VIOL. ® v a.rte./ loc.v %44 / <br />IOFFICE: IINSP: /, i/Zf- . __, d " IRECE <br />� L <br />TITLE: 59 <br />HUT-3 ORIGINAL 5/88 OM <br />L) 5 <br />