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UNDERGROUNK PROGRAM OFFICIAL INSPM&PN REPORT <br />AN JOAQUIN HEALTH DISTRICT'IIIIIIIII11w <br />1601 E. HAZELTON AVE. <br />COUNTY NAME SQ,n�a may, PHONE NO 48894494 COUNTY # � STOCKTON, CA9 <br />SITE NAME: �-+- H K Peva <br />' d- loqSsOC lee?ieS <br />INSPECTION DATE: <br />SITE ADDRESS:a di a 5 9 <br />�j, <br />CITY/STATE/ZIP <br />C/I Ctb��-3 6 S <br />CHANGES SITE/OWNER/PERMIT? <br />YES <br />NO <br />TANK Q / <br />TANK <br />TANK <br />TANK <br />FORM A AND/OR B SUBMITTED? <br />COMPUTER <br />NUMBER ry <br />PER # 1 7d 3 <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />COMPUTER <br />NUMBER <br />TYPE OF INSPECTION <br />SITE COMPUTER # <br />r N o <br />'/ <br />9-3 <br />PER # <br />PER # <br />PER # <br />I �► <br />I <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />EXP. DATE <br />OPERATIONAL TANK <br />T KCONTENTs <br />, <br />MAJOR MINOR <br />PERMIT TO OPERATE <br />1 <br />2 <br />CHANGE IN CONDITIONS TO OPERATE <br />3 <br />4 <br />APPROVED CONSTRUCTION <br />5 <br />6 <br />WRITTEN MONITORING PROCEDURES <br />7 <br />8 <br />T.. <br />APPROVED MONITORING SYSTEM <br />9 <br />10 <br />MONITORING SYSTEM <br />11 <br />12 <br />APPROVED MONITOR FREQUENCY <br />13 <br />14 <br />MONITORING RECORDS MAINTAINED <br />15 <br />16 <br />ACCESS CASING SECURED <br />17 <br />18 <br />PIPING <br />19 <br />20 <br />' <br />INVENTORY RECONCILIATION <br />21 <br />22 <br />TANK GAUGING <br />APPROVED RESPONSE PLAN <br />UNAUTHORIZED RELEASE OCCURRENCE <br />_ <br />SAMPLING <br />N37 <br />__.... <br />._ <br />APPROVED TANK REPAIRS <br />UNAUTHORIZED RELEASES REPORTED <br />SAFETY HAZARD <br />CONDITIONS ABATED <br />TEMPORARY TANK CLOSURE <br />REMOVAL OF RESIDUAL <br />FLAMMABLE VAPORS REMOVED <br />ACCESS LOCATIONS SEALED <br />W43 <br />POWER DISCONNECTED <br />OWNER/OPERATOR MONITORING <br />PERMANENT TANK CLOSURE <br />REMOVAL OF RESIDUAL MATERIALS <br />46 <br />47 <br />PIPING <br />48 <br />49 <br />FLAMMABLE VAPORS REMOVED <br />50ME <br />v <br />UNAUTHORIZED RELEASE <br />51 <br />52 <br />SAMPLING <br />53 <br />IMPROPER ABANDONMENT <br />55 <br />56 <br />THE MARKED IITT'E�MS� REPRESENT VIOLATIONS AND MUST <br />BE CORRECTED AS <br />SYSTEM STATUS (MUST MARK ONE) <br />FOLLOWS: yLd<ag <br />, •a58 <br />57 <br />59 <br />ir or <br />MAJOR MINOR NO <br />VIOL. VIOL. VIOL. <br />OFFICE: <br />INSP: <br />L') -R±`: <br />s� <br />e <br />a 8 a <br />py�y <br />^ <br />ell� <br />a <br />TITI„E <br />u” " " n PHONE: nn o <br />/v— CK: <br />HUT -3 ORIGINAL 5/w Om <br />