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UNDERGROUNDWK PROGRAM OFFICIAL INSPEC N REPORT <br /> V JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA PHONE NO. 4 89 C5205 OUNTY # <br /> 3423 <br /> SITE NAME: g Q0 S G. INSPECTION DATE: <br /> SITE ADDRESS: ` b g(r�� CITY/STATE/ZIP <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> 1 FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTE fi ,,���� COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBEVO)OLI NUMBERI 01000 NUMBER �SJ"v NUMBER <br /> PER# hl�y� PER# S011vrt PER# PER # <br /> InYre K V �+ EXP.DATE EXP.DATE EXP.DATE '//"^" EXP.DATE <br /> OPERATIONAL TANK TANK CONnNT <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 <br /> APPROVED MONITORING SYSTEM 9 110 <br /> MONITORING SYSTEM 11 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 116 <br /> ACCESS CASING SECURED tv <br /> .... <br /> PIPING INVENTORY RECONCILIATION TANK GAUGING APPROVED RESPONSE PLAN UNAUTHORIZED RELEASE OCCURRENCE SAMPLING _..- _. _._ <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 V4142 <br /> FLAMMABLE VAPORS REMOVED <br /> ................ <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 148 149 - <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTE <br /> D AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: N L r �� <br /> ( a o <br /> MAJOR 57 MINOR 58 NO 59 4 <- Psi-'TIV 4v.� C♦ D <br /> VIOL. VIOL ❑ VIOL.❑ O O u u sj 0 402 <br /> F 1�c D M <br /> _2 <br /> OFFICE: INSP: '414 IVE Y. <br /> dY-3 tj TITLE: PHONE: CK: <br /> NUT-3 ORIGINAL 6188 OM <br />