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UNDERGROUNDI�VVK PROGRAM OFFICIAL INSPECjpN REPORT <br /> �d JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA PHONE NO. 468-3423 COUNTY # 3el <br /> SITE NAME: I'o I� 'pf;Ab� �ajL PECTION DATE: <br /> SITE ADDRESS: 2 b 3 ? < j�i 1 CITY/STATE ZIP �� <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK Y TANK TANK TANK b <br /> FORM AAND/OR B SUBMITTED? coMPUTF,R COMPUTER COMPUTER COMPUTER <br /> TY P OF I SPECTION SITE COMPUTER# NUMBE d p�� NUMBEF)/( NUMBER NUMBER <br /> PER# - PER # � PER# PER# <br /> EXP.DATE P.DATE XP.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 g 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 /> - -- <br /> INVENTORYRECONCWATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN - 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING - - " - <br /> 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 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED q3 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 - <br /> _.._. <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 MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> s r <br /> 58 59 0 1 ` <br /> NO <br /> VIOL. VIOL57 ca <br /> MAJOR .R ❑ VIOL. <br /> 8121-4- <br /> OFFICE <br /> L$ W S G o <br /> - <br /> OFFICE: INSP:W RECEIVE Y• <br /> I^' <br /> t ��3 TITLE: /�, �/l)t5- PHONE: / RECK: <br /> HUT-3 ORIGINAL <br />