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UNDERGROUN&TANK PROGRAM OFFICIAL INSPECTION REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. p <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY #-3 / <br /> SClif7 CoQ PHONE NO. 468-3423 <br /> SITE NAME: SS �'7�LC�Z( r h INSPECTION DATE: 96 <br /> SITE ADDRESS: CITY/STATE/ZIP/vow Q SoZOS <br /> CHANGES SITE/OWNER/PERMIT? <br /> YES NO TANK O TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# PER# PER# PER# PER# <br /> Or <br /> Y' ►' Loll �- <br /> [I A T d / EXP.DATE" EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR MINOR <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 <br /> APPROVED CONSTRUCTION 5 6 w <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 <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 7/7 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 139 <br /> FLAMMABLE VAPORS REMOVED W43 <br /> _ <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 MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> 57 58 59 <br /> MAJVIOL R ❑ VIOOR LJ "IOL.❑ <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: �EH-S. PHONE: RECK: <br /> HUT-3 ORIGINAL <br />