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ROGRAM OFFICIAL <br /> UNDERGROUN[ N JOAQUIN HEALTH DISTRICT <br /> N REPORT <br /> 1601 E. HAZELTON AVE. COUNTY ' / <br /> STOCKTON, CA 95205 <br /> COUNTY NAME PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: l6 / <br /> SITE ADDRESS: /0;2-'s �Ntie �Q <br /> CITY/ ATE/ZIP CW ?�7(� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK / TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTED COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER#/ PER # l�,am_r PER # PER # PER# <br /> EXP.DATE �-( EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK MAISR' MINOR <br /> PERMIT TO OPERATE 1 2 _.-.._... -. ..._-- . -. . - <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 - --- _ <br /> APPROVED CONSTRUCTION 5 6 __.- - -------- ---" - <br /> -- <br /> WRITTENMONITORINGPROCEDURES 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 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 p37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W444c5f <br /> FLAMMABLE VAPORS REMOVED <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 IT S REPRESENT VIOLATIONS AND MUST BK CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: �`^ •V ` <br /> MAJOR 57 59 <br /> MINOR 58 NO <br /> VIOL. LiVIOL. ❑ VIOL. <br /> OFFICE: INSP: /�/( RECEIVED BY: <br /> TITLE: PHONE: RECK: <br /> 6 Y 5/88 0- <br /> HUT-3 ORIGINAL <br />