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UNDERGROUNI NK PROGRAM OFFICIAL INSPEON'REPORT <br /> N JOAOUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 <br /> f�/l, PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: <br /> Lsf <br /> SITE ADDRESS: / 2, v/ CITY/STATE/ZIP LD <br /> 5:At/-0-Lk - <br /> CHANGES SITE/OWNER/PERMIT? YES O TANK I TANK 0 Z TANKp3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER <br /> COMPUTE COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> b i EXP.DATE' EXP.DATE _EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONN rS <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 FREOUENCY 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 37 <br /> TEMPORARY TANK CLOSURE F <br /> REMOVAL OF RESIDUAL 38 139 <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 MARK EMS R RESENT VIO IONS AND MUST CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: 1 a4t S <br /> 57 58 59 <br /> MAJOR MINOR NO <br /> VIOL. El VIOL ElVIOL <br /> OFFI�C_E� INSP: RECEIV B <br /> . TITLE: /2. E7, <br /> HUT--3 ORIGINAL siea OM <br />