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UNDERGROU D TANK PROGRAM OFFICIAL INSPECTION REPORT <br />PSAN JOAOUIN HEALTH DISTRICT& <br />1601 E. HAZELTON AVE. <br />COUNTY NAME STOCKTON,CA 95205 COUNTY # <br />QA) PHONE NO. 468-3423 <br />SITE NAME: <br />^A N <br />I I <br />c' <br />INSPECTION DATE: <br />7 <br />SITE ADDRESS <br />o <br />CITY/STATE/ZIP1 <br />l� <br />CHANGES SITE <br />OWNER/PERMIT? YES <br />TANK <br />TANK <br />TANK <br />ANK <br />FORM A AND/ <br />R B SUBMITTED? <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />COMPUTER <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />NUMBER <br />PER # <br />TYPE OF INSPECTI <br />DN <br />SITE COMPUTER # <br />r r 6 <br />EXP. DATE <br />EXP DATE <br />EXP DATE <br />EXP DATE <br />OPERATION <br />TANK TANK <br />NTENTs <br />MAJiA <br />I MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONC <br />TIONS TO OPERATE 3 <br />4 <br />APPROVED CON <br />RUCTION 5 <br />6 <br />WRITTEN MONITC <br />RING PROCEDURES 7 <br />8 <br />APPROVED MONI <br />ORING SYSTEM 9 <br />10 <br />MONITORING SYS <br />EM 11 <br />12 <br />APPROVED MONI <br />OR FREQUENCY 13 <br />14 <br />MONITORING REC <br />DRDS MAINTAINED 15 <br />16 <br />ACCESS CASING <br />ECURED 17 <br />18 <br />_ <br />PIPING <br />19 <br />20 <br />_ <br />INVENTORY REC <br />NCILIATION 21 <br />22 <br />TANK GAUGING <br />23 <br />24 <br />APPROVED RESP <br />NSE PLAN 25 <br />26 <br />UNAUTHORIZED F <br />ELEASE OCCURRENCE 27 <br />28 <br />SAMPLING <br />29 <br />30 <br />APPROVED TANK <br />REPAIRS 31 <br />32 <br />UNAUTHORIZED F <br />ELEASES REPORTED 33 <br />34 <br />- <br />... _.._ _..... <br />_. _.. _ <br />SAFETY HAZARD35 <br />36 <br />CONDITIONS ABA <br />rED <br />37 <br />TEMPORARY <br />TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />38 <br />39 <br />FLAMMABLE VAPORS <br />REMOVED 40 <br />ACCESS LOCATIC <br />NS SEALED 41 <br />42 <br />POWER DISCONNECTED <br />- <br />43 <br />OWNER/OPERAT <br />R MONITORING 44 <br />45 <br />PERMANE <br />4T TANK CLOSURE, <br />REMOVAL OF RE <br />IDUAL MATERIALS 46 <br />47 <br />PIPING <br />48 <br />49 <br />- <br />FLAMMABLE VAP <br />RS REMOVED 50 <br />.... <br />UNAUTHORIZED I <br />IELEASE 51 <br />52 <br />SAMPLING <br />53 <br />54 <br />IMPROPER ABAN <br />ONMENT 55 <br />56 <br />UST MARK ONE) <br />THE MARKED ITEMS <br />FOLLOWS: <br />REPRESENT VIOLATIONS <br />AND MUST BE CORRECTED AS <br />SYSTEM STATUS ( <br />57 <br />MAJOR <br />MINOR Q NO E <br />VIOL. <br />VIOL VIOL <br />OFFICE: <br />INSP�OaS <br />^' <br />RECEIVED BY: <br />i <br />PHONE: <br />RECK: <br />TITLE: <br />�� <br />HUT -3 ORIGINAL 5/88 OM <br />