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UNDERGROU TANK PROGRAM OFFICIAL INSP ON REPORT I <br /> AN JOAQUIN HEALTH DISTRICT \\\ <br /> 1601 E. HAZELTON AVE.STOCKTON, CA 2 to <br /> COUNTY NAME �a� Q PHONE NO. 46893423 5205 COUNTY # /> f <br /> SITE NAME: �� u n� - n� INSPECTION DATE: <br /> SITE ADDRESS: C� s�d{Q� CITY/STATE/ZIP T r <br /> CHANGES <br /> AN <br /> FORM RAND/OR B SUVVBMITTEDI?� L� COMPUTER NO TANK ® COMPUTER COMPU!5 TANK TANKTER �� COMPO ER !� <br /> NUMBER NUMBERS"' NUMBER NUMBE�pN / + <br /> TYPE F INSPECTION SITE COMrPUTER# PER# L�Q� PER# F PEV e ,KGYIa�'R' PER#/M,IIA �M- <br /> `/�� 25� EXP.DATE EXP.DATE EXP-DATE EXP.DATE <br /> TANK CONTENTS <br /> OPERATIONAL TANK R34 <br /> 4 hil�� 118 <br /> PERMIT IN OPERATE _ _ <br /> CHANGE IN CONDITIONS TO OPERATE APPROVED CONSTRUCTION WRITTEN MONITORING PROCEDURES APPROVED MONITORING SYSTEM MONITORING SYSTEM APPROVED MONITOR FREQUENCY - <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED 17 16 <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 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> I <br /> REMOVAL OF RESIDUAL W4142 <br /> FLAMMABLE VAPORS REMOVED _.... <br /> ACCESS LOCATIONS SEALED 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 MUS BEC RRECTED AS <br /> � <br /> SYSTEM STATUS I ST MARK ONE) FOLLOWS: �""p- <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL. ❑ VIOL.❑ <br /> OFFICE: INSP: RECEIVED BY: /� • <br /> TITLE: y c� PHONE: LIZ�7V BECK: - <br /> HUT-3 ORIGINAL siae OM <br />