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j UNDERGROUN"TANK PROGRAM OFFICIAL INSP "ON REPORT <br /> JOAQUIN HEALTH DISTRICIr <br /> 1601 E. HAZELTON AVE. r -..• 3 <br /> COUNTY NAME STOCKTON, CA 95205 <br /> PHONE NO. 468-3423COUNTY # <br /> SITE NAME: � � �E <br /> G. ' �. i INSPECTION DATE- <br /> SITE ADDRESS: CITY/STATE/ZIP 1 <br /> CHANGES 51TE/OWNER/PERMIT? YES NO TANK TANK ITANK TANK w <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER <br /> _ PER# a��[� P(ER# I PER# PER# II <br /> —7a.-7k / v✓ 5 r'j EXP DATE EXP DATE EXP DATE EXP DATE k <br /> OPERATIONAL TANK TANK CONTENTS <br /> MAJOR I MINOR <br /> PERMIT TO OPERATE 1 2 Il k <br /> CHANGE IN CONDITIONS TO OPERATE 3 4 � - <br /> APPROVED CONSTRUCTION 5 g - <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 I <br /> MONITORING SYSTEM 11 12 <br /> 5 <br /> APPROVED MONITOR FREQUENCY 13 114 I <br /> MONITORING RECORDS MAINTAINED 15 116 0 <br /> ACCESS CASING SECURED 17 18 ,is� I �- <br /> PIPING 19 20 It ! <br /> INVENTORY RECONCIUATION 21 22 I <br /> TANK GAUGING 23 24 I} <br /> APPROVED RESPONSE PLAN 25 26 I � <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 I t <br /> APPROVED TANK REPAIRS 31 32 j# k <br /> UNAUTHORIZED RELEASES REPORTED 33 34 I� <br /> SAFETY HAZARD 135 136 <br /> CONDITIONS ABATED 37 II <br /> T * 2'-e� 1". {'kFy,a k.s h tr"' .as'�� "+.y,s 'r�, �...� e. e-- ..r„�s.#- <br /> TEMPORARY TANK CLOSURE � �s ��:� . � � ,,,ti � *'r . '� gip; t rYu <br /> REMOVAL OF RESIDUAL 38 39 I fi <br /> FLAMMABLE VAPORS REMOVED 40 �j ! <br /> ACCESS LOCATIONS SEALED 41 42 I <br /> POWER DISCONNECTED m43 <br /> OWNER/OPERATOR MONITORING 44 45 <br /> ERMANENT TANK CLOS <br /> . � � <br /> IM <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 jl4 <br /> FLAMMABLE VAPORS REMOVED <br /> UNAUTHORIZED RELEASE 51 52 I <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 Ij I <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: I fsl k <br /> MAJOR 57 MINOR NO 58 59 I `f <br /> VIOL. ElVIOL. LiVIOL. I <br /> ;I <br /> j} rl <br /> OFFICE: INSP: RECEIVED BY: 4=J2 �T7'Rjz 64 q 14i.6. "1E <br /> _ 1 <br /> I 'I <br /> TITLE: PHONE: BECK: ' <br /> HUT-3 ORIGINAL 5188 O <br />