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UNDERGROUN ANK PROGRAM OFFICIAL INSP ION REPORT G j <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> f� PHONE NO. 468-3423 <br /> SITE NAME: �A S ( a uV r,4 + E�C*U f.)M �C INSPECTION DATE: <br /> SITE ADDRESS: �D13� S, � / 33 CITY/STATE/ZIP yrs d <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANKT K TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> PER# PER# .. PER# PER# <br /> T/ 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 <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 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 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL IqA 139 <br /> FLAMMABLE VAPORS REMOVED 40r45 <br /> ACCESS LOCATIONS SEALED 41 <br /> POWER DISCONNECTED <br /> OWNER/OPERATOR MONITORING 44 <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 VIOLAT%JpSNS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. ❑ VIOL. ❑ VIOL LAd <br /> AA <br /> OFFICE: INSP: AA RECEIVED BY: <br /> TITLE: ,(I C PHONE: RECK: <br /> HUT-3 ORIGINAL siae O� <br />