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UNDERGROUN' TANK PROGRAM OFFICIAL INSPEI'TION REPORT <br /> _-iAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: K \ INSPECTION DATE: z1�,3 <br /> SITE ADDRESS: ` 7 L S-F JA 4 r /14 CITY/STATE/ZIP -5-1ve- t-'Tm-1 <br /> CHANGES SITE/OWNER/PERMIT? YES NO T NK Oj TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? 7Z OMPUTER COMPUTER COMPUTER COMPUTER <br /> TYP OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> ^ G PER# PER# PER# PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MNK COWENTs "' //'yy <br /> MAJOR MINOR r� Ld=0 eqp— <br /> PERMIT TO OPERATE / 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 /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 126 <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 ;44 ;45 <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED <br /> 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 MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 58 MAJOR 57 MINOR NO 59 <br /> VIOL ❑ VIOL ❑ VIOL <br /> OFFICE: LIN — � RECEIVED BY: <br /> PHONE: PECK: <br /> HUT-3 OP!GINA� siae OM <br />