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UNDERGROUN" TANK PROGRAM BFFICIAL INSPE -ION REPORT <br /> _-,AN JOAQUIN HEALTH DISTRICT v <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY <br /> ? <br /> PHONE NO. 468-3423 J <br /> !0 DATE NAME: SHELL F G£ J <br /> SITE ADDRESS: ITY/STATE/ZIP/ L zj/ <br /> 13 1 4�40 Zv <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK ANK 2 TANK ? TANK <br /> FORM A AND/OR B SUBMITTED?E�g COMPUTER COMPUTER COMPUTES COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE-OF OF ION SITE COMPUTER R# <br /> PER# PER# PER# PER#4 /D <br /> EXP.DATE EXP.DATE EXP.DATE E P.DATE <br /> OPERATIONAL TANK TANK CON NT <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 /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> -. <br /> INVENTORY RECONCILIATION 21 22 _- <br /> TANK GAUGING 23 24 y�- <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:58 59 <br /> 0 <br /> MAJOR MINOR NO <br /> VIOL. VIOL. VIOL <br /> OFFICE: INSP: or Q RECEIVED BY: <br /> TITLEA PHONE: BECK: <br /> HUT-3 ORIGINAL siea 0' <br />