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UNDERGROU TANK PROGRAM OFFICIAL INSP TION REPORT <br /> VISAN JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: KG I c.,- 1 n � INSPECTION DATE: <br /> SITE ADDRESS: Lk, . oxr+ <br /> ,ZC7 r, CfTY/STATE/ZIP 1 <br /> l`�-e a✓t1-�cq <br /> CHANGES SITE/OWNER/PERMIT? YES <br /> NO TANK TANK 'L TANK 3 TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPEOFINSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> l.I c PER# PER # PER# PER # <br /> TYPE= <br /> M T 11 5 D EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK w KCOMM 19 <br /> '['u <br /> MAJOR MINOR -T <br /> C.tiO ©®v <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 /I <br /> APPROVED CONSTRUCTION 5 6 dY(/ <br /> WRITTEN MONITORING PROCEDURES 7 8 \ ` <br /> APPROVED MONITORING SYSTEM 9 10 L^ <br /> MONITORING SYSTEM 11 12 - <br /> APPROVEDMONITORFREQUENCY 13 14 tr <br /> MONITORING RECORDS MAINTAINED 15 16 <br /> ACCESS CASING SECURED L2728 <br /> PIPING <br /> INVENTORY RECONCILIATION <br /> TANK GAUGING <br /> APPROVED RESPONSE PLAN UNAUTHORIZED RELEASE OCCURRENCE SAMPLING APPROVED TANK REPAIRS \`�.�u� �I 1UNAUTHORIZED RELEASES REPORTED 1 _ �1SAFETY HAZARD /CONDITIONS ABATED <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS [65 <br /> 47 <br /> PIPING 49 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 52 <br /> SAMPLING IMPROPER ABANDONMENT 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR MINOR NO <br /> 57 58 <br /> VIOL ❑ VIOL ❑ VIOL <br /> OFFICE: INSP: EIVED BY: n i <br /> TITLE: PHONE: ° PECK: <br /> I ' <br />