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UNDERGROUTANK PROGRAM OFFICIAL INSf ' SON REPORT <br />AN JOAQUIN HEALTH DISTRICl• <br />1601 E. HAZELTON AVG- i <br />STOCKTON, CA 95205 COUNTY #3 <br />COUNTY NAME of ,vt 0 PHONE NCI 468-3423 <br />SITE NAME` JC 6 T'S <br />j;` <br />INSPECTION DATE: r, <br />SITE ADDRESS:a CITY/STATE/ZIP <br />! �Q <br />P C-cz <br />/ <br />o r <br />o'n <br />CHANGES SITE/OWNER/PERMIT? <br />YES- <br />NO <br />TANK Q <br />TANK <br />TANK'TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER A 375 <br />PER # <br />COMPUTER <br />NUMBER <br />PER # <br />COMPUTER <br />NUMBER <br />PER # <br />COMPUTER <br />NUMBER <br />PER # <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />3 <br />75 <br />FXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERA ZONAL ANK <br />TANK CONTENTS ...r <br />= x ` <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE W CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 . <br />b <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 i <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 it <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />INVENTORY RECONCILIATION <br />21 <br />22 —_._._.._..__....__.._._._.._..._�i_...........w.............. <br />,_-._..._...__._...____ _ _,.__._ <br />TANKGAUGING <br />23 <br />24 <br />APPROVED RESPONSE PLAN <br />25 <br />26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 <br />28 ---_.._...__,_._.___......_..._- _.._ 4,_..___..... <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK REPAIRS <br />31 <br />32 _-_.._..._....... . <br />UNAUTHORIZED RELEASES REPORTED <br />33 <br />._. <br />34 _ <br />SAFETY HAZARD <br />35 <br />36 <br />CONDITIONS ABATED <br />37 . . <br />TEMPORARY TANK CLOSURE <br />if <br />'k <br />REMOVAL OF RESIDUAL <br />38 <br />139 <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 I* <br />PERMANENT TANK CLOSURE <br />I; <br />- <br />-_ <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />147 �3 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />50 <br />51 <br />_ <br />52 <br />SAMPLING <br />53 <br />G <br />54 (� <br />IMPROPER ABANDONMENT <br />55' <br />56 11 <br />THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLO S:57 <br />C <br />�� <br />58 59 <br />MAJOR NO <br />VIOL. E] VIOL. ❑ VIOL. ❑ <br />E=tl-4�2 — <br />r <br />I� <br />OFFICE: <br />INSP: <br />(,� RECEIVED BY: <br />T TLE: <br />I� <br />oy <br />ONE: :, <br />RECK: <br />_ <br />I <br />HUT -3 ORIG(NAL II siaa OM <br />