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UNDERGROUI:� TANK PROGRAM OFFICIAL INSPT ION REPORT <br /> '1%.,8AN JOAQUIN HEALTH DISTAICYAIJ <br /> 1601 E. HAZELTON AVE. <br /> �^ STOCKTON, CA 95205 C, �-^ <br /> COUNTY NAME �L COUNTY #PHONE NO. 468-3423 I� //77 ! l�/�a <br /> SITE NAME: �' 7"' / LQ INSPECTION DATE: <br /> SITE ADDRESS: Q S . • � ��� CITY/STATE/IZIP SfA! c14 gsaa y <br /> CHANGES SITE/OWNER/PERMIT? YES NO TANK TANK I -3 TANK TANK S # <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER i� COMPUTE COMPUTER <br /> NUMBER /O I NUMBER /d I NUMBER 1 O I g NUMBER J Q <br /> TYPE OF INSPECTION ISITE COMPUTER# I <br /> PER# PER# .� i PER # PER#sine I <br /> Ld 1 EXP.DATE' EXP.DATE EXP.DATE EXP.DATE <br /> TANK CONTENTS z -s �s a.F � . ,-:' <br /> OPERATIONAL TANK MAJOR MINOR nAa .' � � . <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 9 110 <br /> MONITORING SYSTEM 11 12 - <br /> APPROVED MONITOR FREQUENCY 13 14 - —Ii 1 _ <br /> MONITORING RECORDS MAINTAINED 15 16 H - <br /> ACCESS CASING SECURED 17 18 II I <br /> PIPING 19 20 0 k _ <br />{ INVENTORY RECONCIUATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 �I <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 I� <br /> APPROVED TANK REPAIRS 31 32 fl <br /> UNAUTHORIZED RELEASES REPORTED 3334 <br /> SAFETY HAZARD 35 36 _ _ <br /> __- _ -_---- -- -------- ---- _�_-�W <br /> CONDITIONS ABATED 37 IJ <br /> TEMPORARY TANK CLOSURE ` . <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 i <br /> OWNER/OPERATOR MONITORING 44 j 45 <br /> PERMANENT TANK CLOSURE �� � � <br /> �K t <br /> ryygt <br /> `i v :A� <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 1P <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 11 -- <br />+: UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 _- <br /> f THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) _SQfU � Ir 1� Q <br /> FOLLOWS: <br /> VIOL MAJOR MIN❑ MOOR LJ VIOL. <br /> ❑ + <br /> OFFICE: INSP: RECEIVED <br /> TITLE:S6/YLFYt(fU 441�-/ PHONE: f BECK: ; <br /> HUT-3 ORIGINAL <br />