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UNDERGROUND""NK PROGRAM OFFICIAL INSPECT'-1N REPORT r9 2-or- 3 <br /> a.N JOAQUIN HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # 3 <br /> PHONE NO. 468-3423 <br /> SITE NAME: e r INSPECTION DATE: <br /> SITE ADDRESS: S� CITY/STATE/ZIP S7)CO f S^Zp <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBERS-dO G NUMBER NUMBER NUMBER <br /> ,Q� / p PER# I1S2.1 PER# PER# PER# <br /> —wow �'^'""V✓w ( U V EXP.DATE 1 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 t37 <br /> APPROVED RESPONSE PLAN 25 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 <br /> SAMPLING 29 <br /> APPROVED TANK REPAIRS 31 <br /> UNAUTHORIZED RELEASES REPORTED 33 <br /> SAFETY HAZARD 35 <br /> CONDITIONS ABATED - <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL W43 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED <br /> POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50mm <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: 3 <br /> 57 59 <br /> MAJOR MINOR 58 NO <br /> VIOL. ❑ VIOL. ❑ VIOL. <br /> OFFICE: INSP:, RECEIVED BY: <br /> TITLE: V PHONE: PECK: <br /> HUT-3 ORIGINAL seas ©, <br />