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PROGRAM OFFICIAL INSPF <br /> UNDERGROU WAAN JOAQUIN HEALTH DISTRICT W REPORT <br /> t - 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # � <br /> PHONE <br /> TNO. 468-3423 <br /> SITE NAME: ADFGc�'� / N /�✓I�SS/ON INSPECTION DATE: /49 -�f-0 <br /> SITE ADDRESS: &7 e -3: b��T CITY/STATE/ZIP -r4 ( 9 ��3 <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK TANK TANK <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER ' NUMBER NUMBER <br /> TYPE O INSPECTION SITE COMPUTER# PER # PER# PER # PER # <br /> / EXP.DATE 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 ]:5K16 - - <br /> ACCESS CASING SECURED 17 18 -- <br /> PIPING 19 20 ,. --- <br /> INVENTORY RECONCILIATION 21 22 -- <br /> TANK GAUGING 23 24 X ---- <br /> APPROVED RESPONSE PLAN 5 26 -- <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 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 <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED m 43 _. <br /> OWNER/OPERATOR MONITORING 44 45 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS Ec-- <br /> PIPING ..__..�.-_____.__.. _..... __. . ... <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE <br /> SAMPLING <br /> IMPROPER ABANDONMENT <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: y - <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL. VIOL. ❑ VIOL❑ <br /> OFFICE: INSP: R IVED B . <br /> TITLE:RF�fS HO BECK: <br /> 5/88 3, <br /> HUT-3 ORIGINAL <br />