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UNDERGROU ANK PROGRAM OFFICIAL INSP -ION REPORT <br /> .r6AN JOAQUIN HEALTH DISTRICT- <br /> Sall 1601 E. HAZELT 9 AVE. <br /> CONRfY NAME (� STOCKTON, CANO. 46 -3423 COUNTY # 3 <br /> PHONE NO. 468-3423 <br /> SITE NAME: K Q TS �5 INSPECTION DATE: 5 d <br /> SITE ADDRESS: J D CITY/STATE/ZIP p �C <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK Q TANK TANK ANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER A 37,j NUMBER NUMBER NUMBER <br /> sad ^ PER# PER# PER# PER# <br /> v"`^ S P 3 75 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPE ONAL ANK raNKcoNreNrs <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 34 <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 /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 124 1 _ <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 W43 <br /> FLAMMABLE VAPORS REMOVED _ <br /> ACCESS LOCATIONS SEALED <br /> 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 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND rUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLL lv� MINOR NO \ <br /> 57 58 59 <br /> VIOL.' ❑ VIOL ❑ VIOL❑ <br /> OFFICE: INSP: .� RECEIVED BY: <br /> T TLE: ONE: BECK: <br /> HUT-3 ORIG NAL ©" <br />