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UNDERGROU TANK PROGRAM OFFICIAL INS ION REPORT <br />WAN JOAQUIN HEALTH DISTRICV <br />mm <br />1601 E. HAZELTON AVE.r <br />STOCKTON, CA 95205 COUNTY # <br />I <br />COUNTYNAME <br />PHONE 46,8/-3423 <br />�NO. <br />/ <br />SITE NAME: �C L'� W".x��L c�U L+i��l~%%G ECT N DATE: <br />SITE ADDRESS: %r <br />VLA 6"w, r ee) CITY/STATE/P� <br />CHANGES SITE/OWNER/PERMIT? <br />YES NO T K TANK TAIA <br />COMPUTER <br />TANK <br />COMPUTER <br />FORM AAND/OR 8 SUBMITTED? <br />COMPUT�, fJc COMPUTER <br />NUMBE r NUMBER NUMBER <br />NUMBER <br />TYPF,gF INSPECTION SITE COMPUTER # PER y�7, O / PER # PER # <br />e,, EXP. tDATE EXP. DATE EXP. DATE <br />PER # <br />EXP. DATE <br />OPERATIONAL TANK <br />TANK CONTENTS <br />, <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 4 <br />APPROVED CONSTRUCTION <br />5 6 <br />WRITTEN MONITORING PROCEDURES <br />7 8 - <br />--- - <br />APPROVED MONITORING SYSTEM <br />9 10- <br />- <br />MONITORING SYSTEM <br />11 12 <br />-- <br />APPROVED MONITOR FREQUENCY <br />13 14 <br />MONITORING RECORDS MAINTAINED <br />15 16 <br />- -- <br />ACCESS CASING SECURED <br />17 18 <br />PIPING <br />19 20 <br />._ <br />INVENTORY RECONCILIATION <br />21 22 <br />-- <br />-- - — <br />TANK GAUGING <br />23 24 <br />_ <br />APPROVED RESPONSE PLAN <br />25 26 <br />UNAUTHORIZED RELEASE OCCURRENCE <br />27 28 - <br />.- <br />SAMPLING <br />29 30 <br />APPROVED TANK REPAIRS <br />31 32 <br />-- <br />UNAUTHORIZED RELEASES REPORTED <br />33 34 --- <br />— <br />SAFETY HAZARD <br />35 36 <br />CONDITIONS ABATED <br />37VA <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />PIPING <br />FLAMMABLE VAPORS REMOVED <br />UNAUTHORIZED RELEASE <br />SAMPLING <br />IMPROPER ABANDONMENT <br />SYSTEM STATUS (MUST MARK ONE) <br />MAJOR 57 MINOR 58 NO <br />VIOL. ❑ VIOL. F1 NO <br />OFFICE: I <br />HUT -3 <br />MIMIIIIIIIII <br />mm <br />TITLAF* <br />ORIGINAL <br />3 IEPRESENT IOLATI <br />+ <br />i <br />EIVED B <br />ND MUST 13� CORRECTED AS <br />RFCK: <br />5/88 U M <br />