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UNDERGROUNJWANK PROGRAM OFFICIAL INSPFWON REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # TS <br /> PHONE NO. 468-3423 <br /> SITE NAME: INSPECTION DATE: ? �Z <br /> SITE ADDRESS: / CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? ES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED. COMPUTE COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTfBR# PER <br /> # PER# PER# PER# <br /> 2 Jr00 EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK MAJOA—J-0 NTs <br /> R FMMINOR <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 [33 <br /> 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 28 _ <br /> SAMPLING 30 <br /> APPROVED TANK REPAIRS 32 <br /> UNAUTHORIZED RELEASES REPORTED 34SAFETY HAZARD 36 - <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W444�1 <br /> FLAMMABLE VAPORS REMOVED 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 T <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> of 0 All 4 <br /> 57 58 <br /> MAJOR MINOR NO 59 <br /> VIOL. VIOL. VIOL <br /> OFFICE: i INSP:�q/ i „ „ RECEIVED BY: <br /> TITLE: PHONE: BECK: <br /> HUT-3 ORIGINAL siva OM <br />