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UNDERGROUN&TANK PROGRAM OFFICIAL INSPON REPORT <br /> AN JOAQUIN HEALTH DISTRICTOP <br /> 1601 E. HAZELTON AVE. <br /> STOCKTON, CA 95205 COUNTY # <br /> COUNTY NAME PHONE NO. 468-3423 <br /> SITE NAME: ©a INSPECTIONDATE: <br /> SITE ADDRESS: � ,� C�,ic� CITY/STATE/ZIP <br /> i <br /> CHANGES SITE YES NO TANK CY TANK fes'Z TANK 4" TANK <br /> FORM RAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF SPEGTION SITE COMPUTER# PER# PER# PER# PER# <br /> Z3 l'6 lZ- EXP DATE EXP.DATE EXP DATE EXP DATE <br /> OPERATIONAL TANK TANK eaNr <br /> MAJOR NO <br /> MINOR �� ?S G✓T"� C!`� <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 J — <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 29 130 <br /> APPROVED TANK REPAIRS 31 132 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <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 /> V. <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 1 53 54 _ <br /> IMPROPER ABANDONMENT 155 156 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR NO <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INSP RE EIVED BY: <br /> TITLE. PHO E � �33G R CK: f . a7'1� <br /> NUT-3 ORIGINAL <br />