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UNDERGROI TANK PROGRAM OFFICIAL INS -CTION REPORT <br /> ;AN JOAQUIN HEALTH DISTRIC-v <br /> - 1601 E. HAZELTON AVE. COUNTY #�� <br /> �-+ STOCKTON, CA 95205 <br /> COWY NAME CG- u N PHONE NO. 468-3423 <br /> SITE NAME: / - Sl�e �- INSPECTION DATE: 1010, <br /> SITE ADDRESS: dly4E. O (o �S CITY/STATE/ZIP N <br /> CHANGES SITE/OWNER/PERMIT? Y TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION E COMP # ER# PER# PER# PER # <br /> 7S v <br /> �Qpo/jlr EXP.DATE' EXP.DATE EXP.DATE EXP DAl E <br /> OPERATIONAL TANK N15 <br /> MAJOR 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 13 114 <br /> MONITORING RECORDS MAINTAINED 15 116 1 <br /> ACCESS CASING SECURED K2728 <br /> PIPING _ <br /> INVENTORY RECONCILIATION <br /> TANK GAUGING <br /> APPROVED RESPONSE PLAN <br /> UNAUTHORIZED RELEASE OCCURRENCE SAMPLING APPROVED TANK REPAIRS UNAUTHORIZED RELEASES REPORTED SAFETY HAZARD CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 1 139 _ <br /> FLAMMABLE VAPORS REMOVED W44457 <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <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 5 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: fee Ahw!' <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL W VIOL ❑ VIOL❑ <br /> OFFICE: INSP: RECEIVED BY, <br /> TITLE: .Q6#,S PHONE: PECK: <br /> HUT-3 7� ORIGINAL s'RA n <br />