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UNDERGROUND 'NK PROGRAM OFFICIAL INSPEC "1N REPORT <br /> . N JOAQUIN HEALTH DISTRICT .� <br /> 1601 E. HAZELTON AVE. <br /> couuyNSE - STOCKTON, CA 95205 -361 <br /> PHONE NO. 468-3423 cawy # <br /> SITE NAME: INSPECTION DATE:' <br /> SITE ADDRESS:L�J22C ie. /�,R,�OzEE CITY/STATE/ZIP S/ <br /> CHANGES SITE/OWN�E�R/JPERMIT?` YES NO TANK / TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMP R COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTE # NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# PER# PER# <br /> L- EXP.DATE EXP.DATE E .DATE ATE <br /> OPERATIONAL TANK �N1CONTEN7S <br /> MAJOR I MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 <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 /> 17 18 <br /> ACCESS CASING SECURED <br /> PIPING 19 20 _... _. <br /> INVENTORY RECONCILIATION 21 22 _ <br /> TANK GAUGING 23 24 <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 <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 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 /> MAJOR 57 MINOR 58 NO 9 <br /> VIOL. ElVIOL. ❑ VIOL <br /> OFFICE: INSP: � �L� RECEIVED BY: <br /> TITLE: ' 0 <br /> ., PHONE: BECK: <br /> qAE?q�z 7w <br /> HUT-3 ORIGINAL 5/88 © <br />