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UNDERGROUNKNK PROGRAM OFFICIAL INSPE^' ON REPORT <br /> N JOAQUIN HEALTH DISTRICT ji <br /> 1601 E. HAZELTON AVE. <br /> COUNTY NAME STOCKTON, CA 95205 COUNTY # <br /> PHONE NO. 468-3423 <br /> SITE NAME: J S / INSPECTION DATE: 1711 _7-71,7z, <br /> SITE ADDRESS: /Q 00 x/ 9 CITY/STATE/ZIP���Izb/C41�iZZO <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK-0I TANK -OZ TANK -05 TANK -.c, <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INSPECTION SITE COMPUTER# <br /> /J .��/ PER # PER# PER# PER# <br /> /sa�-2 Y 16 5--c&-7X I 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 4 v" •/ _ <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 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 23 124 <br /> APPROVED RESPONSE PLAN 25 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 I 38 139 <br /> FLAMMABLE VAPORS REMOVED W44475 <br /> ACCESS LOCATIONS SEALED POWER DISCONNECTED OWNER/OPERATOR MONITORING <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <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:58 59 <br /> FrE 3 <br /> MAJOR57 MINOR NO <br /> VIOL. VIOL. VIOL. <br /> OFFICE: INSP� � RECEIVED BY: <br /> / /�l�loe9 �/, lrwY4�1� /jCiQit�o.-G�} ZZGJ <br /> TITLE: !�/- S_ PHoyeo7 ) R Ky <br /> HUT-3 ORIGINAL (1 siae OM <br />